title: Seize the moments: missed opportunities to immunize at the family practice level.
abstract: BACKGROUND
  Missed immunization opportunities (MOs) are a significant barrier to achieving high immunization coverage.
  
  
  OBJECTIVE
  To describe the nature of MOs to immunize within primary care in New Zealand and their effect on immunization completeness.
  
  
  METHODS
  Audit of medical records of approximately 10 randomly selected children <2 years old from each of 62 primary care practices in Auckland, New Zealand.
  
  
  RESULTS
  The 616 audited children made 10 094 visits to primary care practices. MOs occurred at 97% (60) of practices, in 556 (5.5%) of visits, and 31% of the children had one or more visits that were an MO. Overall, children who had any recorded MO visit were 3.1 times more likely to be incompletely immunized than children who had no recorded MO (95% CI 1.87-5.14). Children with the greater percentage of overall visits that were MOs had up to a 9 times increased likelihood of incomplete immunization compared to those who had no MO visits. Nurse visits have less MOs than doctor (1.5% versus 6%) but are more likely to occur within well-child visits.
  
  
  CONCLUSIONS
  MOs are common in primary care practices, occurring in nearly one-third of visiting children. The risk of under-immunization increases with the increasing percentage of visits that are MOs. Overall strategies directed at reducing MOs need to focus on a range of aspects for the practitioner and the practice system.
authors.affiliation: Immunisation Advisory Centre, Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand. n.turner@auckland.ac.nz
authors.forename: Nikki
authors.initials: N
authors.lastname: Turner
authors.forename: Cameron
authors.initials: C
authors.lastname: Grant
authors.forename: Felicity
authors.initials: F
authors.lastname: Goodyear-Smith
authors.forename: Helen
authors.initials: H
authors.lastname: Petousis-Harris
mesh_terms: D005194:Family Practice / Q000379:methods* / Q000592:standards; D006291:Health Policy; D006801:Humans; D007114:Immunization / Q000379:methods*; D007115:Immunization Schedule; D007223:Infant; D008485:Medical Audit; D009520:New Zealand; D009819:Office Visits; D010818:Practice Patterns, Physicians'; D014504:Urban Health