|For many years, influenza vaccination in the Netherlands has been administered
by general practitioners (GPs), with whom every person is registered. Nine
out of ten practices use one of six approved general practice information
systems (GPIS). The exponential growth in use of computerised medical records
in countries such as the Netherlands and the United Kingdom (UK) may be
considered one of the major advances in recent years with regard to population-based
disease prevention. The patient list and automation make systematic prevention
in general practice feasible.
In 1995, the Dutch Minister of Health financed a prevention project -
"tailor-made prevention, managed by the professional organisations
for GPs - that focused initially on influenza vaccination and Pap smear
screening. In all 23 districts of the National Association of General
Practitioners a practice facilitator and a coordinating GP were employed,
to support GPs in organising the influenza vaccination in their practices.
Special software for the GPIS was developed, to facilitate the selection
of at risk groups and to minimise the amount of paperwork
associated with the vaccination. Guidelines on influenza vaccination from
the Dutch College of General Practitioners were distributed. Support was
offered to all practices.
The project's outcome was evaluated by the Department of General Practice
of Utrecht University, by means of a questionnaire to a random sample
of one in three general practices. The organisation of influenza vaccination
improved considerably: 66% of the practices sent postcard invitations
in 1996 compared with 40% in 1994, and 76% used special tags in their
GPIS in 1996 compared with 58% in 1994.
The influenza vaccination rate in high risk groups in the Netherlands
has improved considerably in recent years. Each year the Health Council
of the Netherlands publishes guidelines for influenza vaccination. In
1996 in the light of recent research (1-4) vaccination for all people
over 64 years of age was recommended in the national guidelines for the
first time, along with the usual at risk groups of heart, lung, and diabetes
Influenza vaccination is recommended for about 19% of the population.
In 1996, the change in policy was published just before the vaccination
season, at the end of October. Despite this late notification the vaccination
rate in at risk groups rose from 52% in 1995 to 63% in 1996. The vaccination
rate in " healthy " over 64s - without any other risk
factor was 58%. A total of 15% of the population was immunised.
In 1997 a new distribution system for influenza vaccines was developed.
In May, all practices ordered the needed vaccines, postcards, and information
slips they needed from a single centre. The call/recall system was stimulated
by the national prevention project. In October the vaccines were distributed
to practices, making a visit to the pharmacy to collect your own dose
of vaccine no longer necessary.
The vaccination is paid for by the National Health System, so there are
no financial barriers for at risk groups. The GP sends the bill for vaccination
of at risk patients to a central administration office. The goal for the
vaccination coverage in 1997 was 75% of all risk groups, including the
healthy over 64s, but the amount of ordered vaccines would enable 80%
to be vaccinated.