Vaccine 19 (2001) 4760–4767 Importance of patients’ perceptions and general practitioners’ recommendations in understanding missed opportunities for immunisations in Swiss adults Patrick A. Bovier a, *, Eric Chamot b , Martine Bouvier Gallacchi c , Louis Loutan a a Department of Community Medicine, Genea Uniersity Hospitals, 24 Micheli -du -Crest, 1211 Genea 14, Switzerland b Institute of Social and Preentie Medicine, Genea Uniersity, 1 Michel -Seret, 1211 Genea 4, Switzerland c General Internal Medicine Practice, ia Pocobelli 16, 6815 Melide, Switzerland Received 16 January 2001; received in revised form 30 May 2001; accepted 31 May 2001 Abstract Over the last decades, tremendous efforts have been made to strengthen childhood immunisation programs. However, the burden of influenza and pneumococcal infections remains disturbingly high in adults and elderly. We conducted a cross-sectional self-administered mail survey to identify characteristics associated with low use of recommended vaccines in adult patients attending routine primary care appointments in Switzerland. Tetanus vaccination was reported by 84% of respondents aged 16 – 34, and by only 42% of respondents aged 65 or more. For influenza and pneumococcal vaccination, of high-risk patients (age 65 or history of diabetes, kidney, heart, or chronic pulmonary disease), only 41% were on schedule for influenza and 6% for pneumococcal vaccination. Compared with patients from the German- and Italian-speaking areas of the country, patients from the French-speaking region were more likely to report past immunisation against influenza and pneumococcal disease or a recent physician’s recommendation for immunisation against influenza, but equally likely to have ever refused influenza vaccination. For all three diseases, area of residence, physician’s recommendation for immunisation, and patient’s perceived usefulness of vaccination were independently and significantly associated with vaccination status. Although patient’s opinion is an important determinant of vaccination coverage in adults, lack of physician’s encouragement accounted for most missed vaccination opportunities in this study. The higher vaccination coverage among patients from the French-speaking area suggests that the promotion campaigns 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. © 2001 Published by Elsevier Science Ltd. Keywords: Primary care; Adult; Immunisation www.elsevier.com/locate/vaccine 1. Introduction Over the past decades, tremendous efforts have been made world-wide to strengthen childhood immunisa- tion programs. Immunisation coverage has increased in most regions and cases of vaccine-preventable diseases have fallen by 90 – 100% in children of industrialised nations. Polio eradication may be on the horizon. In contrast to these successes, the burden of influenza and pneumococcal infections remains disturbingly high in older adults of most countries, and cases of tetanus are still regularly reported. A common characteristic of all three diseases is that their residual incidence in older age groups results directly from adults’ underimmunisa- tion [1–4]. Several factors have been proposed to account for the poor implementation of recommended schedules for immunisations in adults [5]: (1) The limited perception by health care providers and the general public that adult vaccine-preventable diseases are important health problems; (2) doubts in the doctors’ and patients’ minds about the efficacy and safety of the vaccines used for adults; (3) the complexity of vaccine schedules in * Corresponding author. Tel.: +41-22-372-9610; fax: +41-22-372- 9626. E-mail address: patrick.bovier@hcuge.ch (P.A. Bovier). 0264-410X/01/$ - see front matter © 2001 Published by Elsevier Science Ltd. PII:S0264-410X(01)00223-7