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Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice
  1. Laura J Dexter1,
  2. M Dawn Teare2,
  3. Matthew Dexter3,
  4. A Niroshan Siriwardena4,
  5. Robert C Read1
  1. 1Department of Infection and Immunity, The University of Sheffield Medical School, Sheffield, UK
  2. 2Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
  3. 3Retford Health, Retford Primary Care Centre, Retford, UK
  4. 4Lincoln School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, UK
  1. Correspondence to Laura J Dexter; l.dexter{at}


Objective To identify practice strategies associated with higher flu vaccination rates in primary care.

Design Logistic regression analysis of data from a cross-sectional online questionnaire.

Setting 795 general practices across England.

Participants 569 practice managers, 335 nursing staff and 107 general practitioners.

Primary outcome measures Flu vaccination rates achieved by each practice in different groups of at-risk patients.

Results 7 independent factors associated with higher vaccine uptake were identified. Having a lead staff member for planning the flu campaign and producing a written report of practice performance predicted an 8% higher vaccination rate for at-risk patients aged <65 years (OR 1.37, 95% CI 1.10 to 1.71). These strategies, plus sending a personal invitation to all eligible patients and only stopping vaccination when Quality and Outcomes Framework targets are reached, predicted a 7% higher vaccination rate (OR 1.45, 95% CI 1.10 to 1.92) in patients aged ≥65 years. Using a lead member of staff for identifying eligible patients, with either a modified manufacturer's or in-house search programme for interrogating the practice IT system, independently predicted a 4% higher vaccination rate in patients aged ≥65 years (OR 1.22, 95% CI 1.06 to 1.41/OR 1.20, 95% CI 1.03 to 1.40). The provision of flu vaccine by midwives was associated with a 4% higher vaccination rate in pregnant women (OR 1.19, 95% CI 1.02 to 1.40).

Conclusions Clear leadership, effective communication about performance and methods used to identify and contact eligible patients were independently associated with significantly higher rates of flu vaccination. Financial targets appear to incentivise practices to work harder to maximise seasonal influenza vaccine uptake. The strategies identified here could help primary care providers to substantially increase their seasonal flu vaccination rates towards or even above the Chief Medical Officer's targets.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Dexter LJ, Teare MD, Dexter M, et al. Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice. BMJ Open 2012;2:e000851. doi:10.1136/bmjopen-2011-000851

  • Contributors LJD designed, carried out and coordinated analysis and reporting of the study and also drafted and revised this manuscript. MDT contributed to statistical aspects of design, carried out the formal data analysis and contributed to the manuscript. MD and ANS contributed to primary care and policy aspects of study design and interpretation and also revised the manuscript. RCR contributed to study design and interpretation and revised the manuscript. He is guarantor.

  • Funding This study was an independent report commissioned and funded by the Policy Research Programme in the Department of Health, UK (reference number 039/0035). The views expressed are not necessarily those of the Department. The study was sponsored and granted ethical approval by the University of Sheffield. Neither the study sponsor nor the funder played any role in study design; in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the article for publication. All authors had access to the study data (including statistical reports and tables) and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University of Sheffield.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The availability of additional data is subject to consent for its dissemination from the Department of Health Central Commissioning Facility.