title: General practitioners' experiences, attitudes, and opinions regarding the pneumococcal vaccination for adults: a qualitative study.
abstract: BACKGROUND
  Diseases caused by Streptococcus pneumoniae generate substantial morbidity and mortality. Despite official recommendations to vaccinate everyone over the age of 64, the estimated vaccination rate for this target population is around 2%. In Switzerland, pneumococcal vaccinations are for the most part provided by general practitioners (GPs); in addition, a small number of patients get vaccinated during a hospital stay. We wanted to investigate GPs' attitudes and opinions about the pneumococcal vaccination in primary care and why it is so rarely provided.
  
  
  METHODS
  For this qualitative study, we conducted semistructured interviews with 20 GPs. Transcriptions of all interviews were analyzed following the technique of qualitative content analysis, supported by the ATLAS.ti(©) software.
  
  
  RESULTS
  Most GPs reported that they know pneumococcal vaccination is recommended for several risk groups and elderly patients. As to reasons for the low vaccination rate, GPs mentioned the pneumococcal vaccination had little priority in daily practice, especially in comparison with the importance of other vaccinations, namely influenza. This low level of priority was supported by the fact that the GPs rarely ever experienced a case of a severe pneumococcal disease in their daily work. Furthermore, perceived insufficient evidence resulting from existing epidemiologic data and clinical trials enhanced the little attention given to the pneumococcal vaccination.
  
  
  CONCLUSIONS
  We found the generally low level of priority given within a consultation, the missing awareness of this subject in daily practice, and the perception of epidemiologic and scientific data as insufficient, as the reasons for the low rate in pneumococcal vaccinations. Efforts to increase the epidemiologic data on the pneumococcal vaccination should be taken. To increase the vaccination rate, it would be necessary to raise the awareness and priority of the pneumococcal vaccination; a feasible way could be the combination of the seasonal flu vaccination campaign with a campaign for pneumococcal vaccination.
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
authors.forename: Nina
authors.initials: N
authors.lastname: Badertscher
authors.forename: Seraina
authors.initials: S
authors.lastname: Morell
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.forename: Ryan
authors.initials: R
authors.lastname: Tandjung