Systems approaches in general practice
GPs also need to develop strategies to increase coverage within their practices. These strategies should include a systems approach to identify target populations and engage with them. For example, use of electronic records and desktop software to recall patients in target age groups for initial and repeat vaccines is effective and possible in all primary care clinics.
Role of government
Multiple models exist around the world for vaccine funding policies: co-pay percentages, fixed costs with subsidies, full funding or no funding at all. Any policy must be simple, and identifying who qualifies should not be overly complex. Although accepting incremental gains is important as we move forward, the only vaccine programs in the world that meet targets are fully funded. Funding for pertussis booster vaccine in older people is needed in Australia.
Maximising access to vaccination
Broadening the base of sites to access vaccine beyond general practice will help increase coverage. Nurse-managed public immunisation clinics, immunisation by pharmacists and immunisation clinics in nursing homes have all been successful in increasing coverage.11 Opportunistic settings have been used in other countries, including an influenza vaccine van in the car park before a major football game in the US city of Seattle and immunisation clinics in supermarkets.
Recording, monitoring and evaluating vaccine programs in older people
To ensure improvements in vaccination programs for older people, program targets should be set and linked to monitoring and surveillance systems for both the disease and vaccination coverage. In particular, recording the burden of disease and its personal and financial impacts is crucial for obtaining financial support for programs.
Accurate recording of the time of vaccine administration is important for developing a recall system, measuring vaccine coverage, monitoring vaccine safety and providing payments for providers.
The uptake of vaccination in older people is suboptimal but attracts little focus at present. A move to a whole-of-life approach to immunisation and acknowledgement that preventive health care should be fair and equitable for all are needed. A national strategy should be developed that incorporates improved messaging about the risks versus benefits of vaccination and better data on vaccine coverage as well as disease incidence and outcome. The public messaging strategies should be freely available for use by other organisations and suitable for multiple-use formats. For example, enabling groups such as Diabetes Australia, the Heart Foundation and others to use pre-developed messages with their constituencies will aid message dissemination.
An increased focus on vaccination is needed in primary care, as well as better linkages between vaccination activities there and in other settings such as pharmacies. Targets for improved outcomes should be set and monitored. MT