title: [Do organizational barriers to pneumococcal and influenza vaccine access exist?].
abstract: BACKGROUND
  Despite the implementation of a Quebec immunization program against influenza and pneumococcal disease (PQIIP), vaccine coverage has remained low. There have been many studies on personal barriers to vaccination, but few have explored other kinds of barriers.
  
  
  OBJECTIVE
  To explore the presence of barriers in relation to the organization of the health care system and to propose recommendations for increasing vaccine coverage.
  
  
  METHODS
  Within a mixed protocol, a phone survey of 996 people in the target population and a case study implicating the follow-up of the PQIIP with all the site and actor categories via 43 semistructured interviews and 4 focus groups were realized. Survey data underwent a descriptive statistical analysis. Qualitative analysis followed the Miles and Huberman approach.
  
  
  RESULTS
  The results indicate the presence of barriers with regard to information accessibility. These include access to: the physicians' recommendation, knowledge of the efficacy or the security of vaccines, and admissibility of clients to the PQIIP. Organizational barriers were also found to limit access to vaccination, especially in terms of restricted choices of time and location. Coordination and incentives mechanisms are not optimal. Removal of organizational barriers depends more on strategic rather than structural factors.
  
  
  CONCLUSIONS
  Addressing organizational barriers should be an important component of strategies aimed at improving vaccine coverage. Public health authorities should focus on strategic management of the information and inter-organizational environment.
authors: Equipe de recherche appliquée en santé.
authors: Louise
authors: L
authors: Rousseau
authors: Maryse
authors: M
authors: Guay
authors: Denis
authors: D
authors: Archambault
authors: Zahra
authors: Z
authors: El m'ala
authors: Nadia
authors: N
authors: Abdelaziz
mesh_terms: D001294:Attitude to Health; D017144:Focus Groups; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D007252:Influenza Vaccines; D032541:Mass Vaccination / Q000706:statistics & numerical data; D022242:Pneumococcal Vaccines; D015397:Program Evaluation; D011792:Quebec
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines