Effectiveness of a co-ordinated nation-wide programme to improve influenza immunisation rates in The Netherlands

OBJECTIVE: To assess t he effectiveness of a nation-widemultifaceted intervention programme involving general practitioners (GPs) on influenza immunisation practice. DESIGN: Pragmatic before-after trial using pre- and post-measurement questionnaires. SETTING AND SUBJECTS: Random sample of Dutch general practices. INTERVENTION: During a 2.5-year period (1995-1997) a variety of methods was implemented to enhance physician adoption of the immunisation guideline, including employment of facilitators, information-based methods, small-group consensus meetings, individual instructions and introduction of supportive computer software. MAIN OUTCOME MEASURES: Influenza immunisation practice and influenza vaccine uptake. RESULTS: In 988 practices all influenza vaccination characteristics markedly improved from 1995 to 1997. The most significant changes were found in computerised marking of high-risk patients (from 54% to 82% of practices), computerised selection (41% to 77%) and sending personal reminders (40% to 77%). Vaccine uptake increased from 9% to 16% of the practice population (78% increase, p < 0.001). Uptake was most prominent in urban and single-handed practices and in those with more patients insured through the National Health Service, low GP workload and low baseline uptake. CONCLUSION: Our data suggest that a co-ordinated approach involving primary care physicians can succeed in enlarging the public health impact of a population-based preventive measure.