Importance of patients' perceptions and general practitioners' recommendations in understanding missed opportunities for immunisations in Swiss adults

Over the last decades, tremendous efforts have been made to strengthen chil dhood immunisation programs. However, the burden of influenza and pneumococ cal infections remains disturbingly big in adults and elderly. We conducted a cross-sectional Mh self-administered mail survey to identify characteris tics associated with low use of recommended vaccines in adult patients atte nding routine primary care appointments in Switzerland. Tetanus vaccination was reported by 84% of respondents aged 16-34, and by only 42% of responde nts aged 65 or more. For influenza and pneumococcal vaccination, of high-ri sk patients (age greater than or equal to 65 or history of diabetes, kidney , heart, or chronic pulmonary disease), only 41% were on schedule for influ enza and 6% for pneumococcal vaccination. Compared with patients from the G erman- and Italian-speaking areas of the country, patients from the French- speaking region were more likely to report past immunisation against influe nza and pneumococcal disease or a recent physician's recommendation for imm unisation against influenza, but equally likely to have ever refused influe nza vaccination. For all three diseases, area of residence, physician's rec ommendation for immunisation, and patient's perceived usefulness of vaccina tion were independently and significantly associated with vaccination statu s. Although patient's opinion is an important determinant of vaccination co verage in adults, lack of physician's encouragement accounted for most miss ed vaccination opportunities in this study. The higher vaccination coverage among patients from the French-speaking area suggests that the promotion c ampaigns carried out in this region effectively improved influenza vaccine use. Interventions designed to increase vaccination coverage in adults must help providers incorporate immunisation in routine health care. (C) 2001 P ublished by Elsevier Science Ltd.