Practice systems impact on immunisation rates
A range of practice policies and systems have considerable impact on immunisation uptake. Vital systems for high immunisation
- A clear enrolment policy
- Early enrolment of children
- Good data entry of records
- Systematic precall* & recall
- Regular audit
*Precall is a reminder sent prior to the vaccination being due
While around 60-70% of children receive immunisation with a simple precall system and organised practice, the other
20-30% requires extra time and effort in tracking and recalling. This requires committed staff time, a good understanding
of how to use a PMS and effective use of National Immunisation Register (NIR) status queries. Practices with high staff
turnover or inexperienced staff are likely to have greater problems with entering quality, accurate data.
There are significant numbers of errors occurring in immunisation data entry at the practice level. Recommendations
to improve this include early enrolment of infants, standardised approaches to entering data, checking data entry quality,
improving staff training in use of the PMS, and developing a focus on timeliness, as well as coverage, with regular audits.
Performance feedback to the practice has been shown internationally and locally to improve coverage rates.
Other important ways to improve immunisation coverage and timeliness include making immunisation services available
at all possible hours, and having staff available at all times who can vaccinate (including GPs if the practice nurse
is not present).
Parent/Community knowledge and attitudes
In New Zealand it is known that 20% of parents consider that good healthy living will be enough to prevent disease without
the need for vaccination.8 Caregiver's knowledge and attitudes impact on immunisation uptake
to a lesser extent than practice characteristics but the impact is still significant. The media, fuelled at times by the
anti-immunisation lobby, can have dramatic effects on parental confidence in vaccination as has been seen with the abiding
myth that MMR may be linked to autism despite the lack of any scientific backing.
The importance of the primary care provider relationship with the parent is vital to parental confidence. A knowledgeable,
committed and confident provider with a good relationship with their patients, is likely to overcome many parental myths