Improving influenza vaccine coverage in at-risk groups. Good intentions are not enough

To raise awareness of the need for annual influenza vaccination in the elderly (those 65 years of age and older), and of the efficacy of organisational practice strategies (specifically at-risk registers and reminder systems) to improve influenza vaccine coverage.

Extensive search of the existing literature using MEDLINE and manual searching techniques. Recent key review articles on organisational strategies were also studied.

Primary source articles were included if they evaluated the efficacy of vaccination and the various strategies used to improve coverage. More attention was paid to randomised controlled trials, although other study designs were considered. A formal algorithm for estimating the effect of organisational strategies was not used; rather, appropriate studies which highlighted advantages and disadvantages were selected.

Current levels of vaccination for influenza are low. Negative patient attitudes and lack of an organised and systematic approach are the major barriers to improving vaccination rates. Vaccination coverage can be improved by 10%-30% by use of at-risk registers and reminder systems.

Further research is required to determine the impact of both patient attitudes and reminder systems on influenza vaccination rates. A randomised controlled trial is currently underway to look at both these issues. Provider and patient reminder systems should be incorporated into general practice to improve the influenza vaccination rate.