title: General practice factors and MMR vaccine uptake: structure, process and demography.
abstract: BACKGROUND
  Despite the fall in MMR uptake between 1998 and 2004, some general practices managed to sustain remarkably high MMR coverage.
  
  
  METHODS
  The aim of the study was to identify general practice factors associated with high MMR vaccine coverage. The study population included 257 general practices in Cumbria and Lancashire in 2005. Practice level MMR coverage data for 2002-04 were obtained from the child health information systems of eight Primary Care Trusts (PCTs) and linked to information on practice structure, census indicators for deprivation and ethnicity data at lower level super output area and information from a questionnaire survey of practice nurses.
  
  
  RESULTS
  Mean MMR uptake was 86.4% with a range from 59 to 98%. Twenty-eight per cent (74/257) practices achieved the Department of Health higher target payment level of 90%. The uptake was not associated with practice size, the number of general practitioners (GPs) or practice nurses. There was no correlation between uptake and deprivation or the percentage of non-white population. There was a strong negative association between MMR uptake and barriers to housing and services (r = -0.230, P < 0.001). On the basis of a questionnaire response rate of 75.9%, having a strategic approach to MMR with clear objectives was associated with MMR uptake of 90% or above (odds ratio, 3.76, 1.26-12.04). There was no association between immunization by GP, practice nurse or health visitor.
  
  
  CONCLUSIONS
  There are no easily identifiable characteristics of high-uptake MMR practices although having a strategic approach to MMR is important. Practices in rural areas should endeavour to ensure easy access to child vaccination. High uptake can be achieved by practices in deprived areas. Further research is needed to identify practice system factors associated with high MMR uptake.
authors.affiliation: Cumbria and Lancashire Health, Protection Unit, York House, Ackhust Business Park, Foxhole Road, Chorley, Lancashire PR7 1NY, UK. kenneth.lamden@hpa.org.uk
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Lamden
authors.forename: Islay
authors.initials: I
authors.lastname: Gemmell
mesh_terms: D002675:Child, Preschool; D003710:Demography; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D022542:Measles-Mumps-Rubella Vaccine / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014852:Wales
chemical_list: D022542:Measles-Mumps-Rubella Vaccine