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

Objective - To assess the effectiveness of a nation-wide multifaceted inter vention programme involving general practitioners (GPs) on influenza immuni sation practice. Design - Pragmatic before-after trial using pre- and post-measurement quest ionnaires. Setting and subjects - Random sample of Dutch general practices. Intervention - During a 2.5-year period (1995-1997) a variety of methods wa s implemented to enhance physician adoption of the immunisation guideline, including employment of facilitators, information-based methods, small-grou p consensus meetings, individual instructions and introduction of supportiv e computer software. Main outcome measures - Influenza immunisation practice and influenza vacci ne uptake. Results - In 988 practices all influenza vaccination characteristics marked ly improved from 1995 to 1997. The most significant changes were found in c omputerised marking of high-risk patients (from 54% to 82% of practices), c omputerised selection (41% to 77%) and sending personal reminders (40% to 7 7%). 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 Heal th Service, low GP workload and low baseline uptake. Conclusion - Our data suggest that a co-ordinated approach involving primar y care physicians can succeed in enlarging the public health impact of a po pulation-based preventive measure.