Barriers to immunisation in general practice

Objective: To identify barriers to immunisation in general practice. Method: The study was conducted in Perth, Western Australia, as a cross-sec tional postal survey between November 1996 and January 1997. Questionnaires were sent to all known GPs in three of the seven metropolitan Divisions of General Practice, of whom 301 (72%) responded. Results: When a child presented with a minor illness and there were no cont raindications to immunisation, 62% of GPs said they would always or frequen tly offer immunisation. Immunisation would be withheld incorrectly because of an upper respiratory tract infection by 43% of GPs and because of antibi otics by 50%. Combined diphtheria-tetanus vaccine (CDT) would be substitute d incorrectly for diphtheria-tetanus-pertussis vaccine (DTP) by 41% if ther e was an unexplained temperature of 38 degrees C following a previous dose of DTP While more than half (56%) reported that vaccines were correctly sto red, only 26% reported that the refrigerator temperature was checked daily. Eighty per cent reported that they completed an Australian Childhood Immun isation Register notification form. Conclusions: GPs require ongoing education about contra-indications to immu nisation and when substitution of CDT for DTP is required. There is room fo r increased opportunistic immunisation and encouragement to notify the Aust ralian Childhood Immunisation Register when they immunise a child. Implications: A major challenge is to find an innovative approach that woul d encourage and enable GPs to assess immunisation status and offer immunisa tion where appropriate at every clinical encounter.