The use of patient and physician reminders for preventive services: results from a National Study of Physician Organizations

BACKGROUND: Clinical preventive services improve patient health, and reminder systems can increase the use of such services. However, physician organizations often underutilize clinical preventive service reminders. Little is known about the incentives, capabilities, and organizational characteristics associated with the use of reminders by physician organizations. METHODS: The predictors of patient and physician reminder system use were examined in a sample of 1,104 US physician organizations. The cross-sectional sample was obtained through a telephone survey with a 70% response rate. RESULTS: Fifty-one percent of physician organizations used mammogram reminders, 41% used influenza immunization reminders, and 26% used eye exam reminders for patients. Eighteen percent of physician organizations used computer-generated reminders to physicians. Required reporting of data (P = 0.0006), public recognition for quality (P = 0.0002), and IT capabilities (P < 0.0001) were strongly associated with patient reminder use. Medical groups were more likely to use patient-level reminders than independent practice associations (IPAs) (P < 0.0001). Physician reminder use was related to required reporting of data (P < 0.0001) and IT capabilities (P < 0.0001). CONCLUSIONS: Physician organizations have relatively low use of preventive service reminders to patients and physicians. Offering quality incentives to physician organizations and improving their IT capabilities may increase the use of preventive service reminders and improve the delivery of preventive care.     

The relationship of health beliefs and a postcard reminder to influenza vaccination.

The relationship of certain health beliefs to influenza vaccination and the effect of a postcard reminder on vaccination rates was studied among 232 high-risk patients. In agreement with the Health Belief Model tested, the patients vaccinated believed influenza to be more serious, believed they were more susceptible to influenza, and believed the vaccine to be more efficacious than did patients not vaccinated. Those not vaccinated were less satisfied with their medical care and felt the vaccine was more expensive than those vaccinated. A postcard reminding patients of influenza vaccination was an effective way to increase the vaccination rate. Patients receiving the card had a 59.7 percent vaccination rate compared to a 30.0 percent rate among those not receiving the postcard. This study suggests that a reminder postcard is an effective means to promote influenza vaccination and that these beliefs are important determinants of vaccination behavior.     

Association between patient reminders and influenza vaccination status among children

BackgroundPatient reminders are recommended to increase vaccination rates. The objectives of this study were to estimate the percentage of children 6 months–17 years for whom a patient reminder for influenza vaccination was received by a child’s parent or guardian, estimate influenza vaccination coverage by receipt of a patient reminder, and identify factors associated with receipt of a patient reminder.MethodsNational Immunization Survey-Flu (NIS-Flu) data for the 2013–14 influenza season were analyzed. Tests of association between patient reminders and demographic characteristics were conducted using Wald chi-square tests and pairwise comparison t-tests. Multivariable logistic regression was used to determine variables independently associated with receiving a patient reminder.ResultsApproximately 22% of children had a parent or guardian report receiving a patient reminder for influenza vaccination for their child, ranging from 12.9% in Idaho to 41.2% in Mississippi. Children with a patient reminder were more likely to be vaccinated compared with children without a patient reminder (73.7% versus 55.5%). In the multivariable model, reminder receipt was higher for children 6–23 months compared with children 13–17 years, black children compared with white children, and children whose parent completed the survey in English compared with children whose parent completed the survey in a language other than English or Spanish.ConclusionsAlthough patient reminders are associated with a higher likelihood of influenza vaccination, nationally, less than one-fourth of children had a parent report receiving one. Despite being based on parental report, with its limitations, this study suggests that increasing the number of parents who receive patient reminders for their children may improve vaccination coverage among children.     

Patient views on reminder letters for influenza vaccinations in an older primary care patient population: a mixed methods study

OBJECTIVES: To explore the perspectives of older adults on the acceptability of reminder letters for influenza vaccinations. METHODS: We randomly selected 23 family physicians from each Family Health and Primary Care network participating in a demonstration project designed to increase the delivery of preventive services in Ontario. From the roster of each physician, we surveyed 35 randomly selected patients over 65 years of age who recently received a reminder letter regarding influenza vaccinations from their physician. The questionnaires sought patient perspectives on the acceptability and usefulness of the letter. We also conducted follow-up telephone interviews with a subgroup of respondents to explore some of the survey findings in greater depth. RESULTS: 85.3% (663/767) of patients completed the questionnaire. Sixty-five percent of respondents recalled receiving the reminder (n=431), and of those, 77.3% found it helpful. Of the respondents who recalled the letter and received a flu shot (n=348), 11.2% indicated they might not have done so without the letter. The majority of respondents reported that they would like to continue receiving reminder letters for influenza vaccinations (63.0%) and other preventive services (77.1%) from their family physician. The interview participants endorsed the use of reminder letters for improving vaccination coverage in older adults, but did not feel that the strategy was required for them personally. CONCLUSIONS: The general attitude of older adults towards reminder letters was favourable, and the reminders appear to have contributed to a modest increase in influenza vaccination rates.     

Improving the rates of inpatient pneumococcal vaccination: impact of standing orders versus computerized reminders to physicians.

OBJECTIVE: To determine the impact of interventions using standing orders and computerized reminders to physicians on inpatient pneumococcal vaccination rates relative to a control group. DESIGN: Open trial of the following approaches, each on a different ward: (1) standing orders for vaccination of eligible consenting patients, (2) computerized reminders to physicians, and (3) usual practice. SETTING AND PATIENTS: Four hundred twenty-four patients were admitted to three 30-bed inpatient medical wards during a 4-month period in 1999 at one hospital. Unvaccinated patients 65 years or older and competent to give oral consent were included. INTERVENTION: A pharmacist activated a standing orders protocol for vaccination of all eligible consenting patients on one ward and computerized reminders to physicians on a second ward. A third ward served as a control group. RESULTS: Forty-two patients met inclusion criteria and accepted vaccination in the standing orders arm versus 35 patients in the computerized reminder arm. Vaccination rates on the standing orders ward included 98% of those eligible and accepting vaccination, 73% of eligible patients, and 28% of all patients admitted. Rates on the computerized reminder ward were 23%, 15%, and 7%, respectively. All of the rates from the standing orders ward were significantly greater than those from the computerized reminder ward (P < .0001). Only 0.6% of all patients on the control arm were vaccinated. CONCLUSION: Although both interventions were effective in increasing inpatient pneumococcal vaccination rates relative to baseline practice, physician independent initiation of standing orders was clearly more effective.     

Beliefs and Attitudes about Influenza Immunization among Parents of Children with Chronic Medical Conditions over a Two-Year Period

Influenza vaccination is recommended for children with chronic medical conditions yet is infrequently performed. The reasons for low influenza vaccination rates in this group have not been well studied. We assessed and compared parents of children with chronic medical conditions regarding their beliefs and attitudes about influenza vaccination in 2003 and 2004. Parents of 2- to 13-year-old children with chronic medical conditions from health centers in low-income urban neighborhoods completed a 19-question survey, mailed following the 2002–2003 and 2003–2004 influenza seasons. Parent-reported influenza vaccination rate declined from 2003 (44%) to 2004 (25%). The most important factors related to influenza vaccination status were perceived doctor's recommendation (odds ratio [OR] = 6.0, 95% confidence interval [CI] = 3.7–9.7), parents' belief that the child should be vaccinated (OR = 5.4, 95%CI = 3.3–8.8), relatives' belief that the child should be vaccinated (OR = 1.7, 95%CI = 1.1–2.7), easy access to the doctor's office for a flu shot (OR = 2.4, 95%CI = 1.4–4.2), and receipt of a reminder from the doctor's office (OR = 1.7, 95%CI = 1.1–2.6). In 2004 compared with 2003, fewer parents reported getting a reminder, and fewer believed that their child's doctor recommended flu vaccine. Doctors' recommendation that children with chronic medical conditions should receive an annual influenza vaccine and vaccine availability are important factors that resulted in a higher likelihood of influenza vaccination. Our findings that fewer parents reported receiving reminders and that fewer children were vaccinated in 2004 suggest that sustained improvements in vaccination rates may require continual changes in the format and delivery method of vaccination reminders from physicians.     

Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services

Despite an emerging consensus on appropriate preventive services, a minority of patients receive them. A study was undertaken to assess the impact of computer-generated reminders to adult patients, their physicians, or both patients and physicians on adherence to five recommended preventive services: cholesterol measurements, fecal occult blood testing, mammography, Papanicolaou smears, and tetanus immunization. During the academic year 1988-1989, all 7397 adult patients and their 49 physicians in a university family medicine clinical practice were randomized by practice group into one of four study groups: control, physician reminders, patient reminders, and both physician and patient reminders. Adherence was defined in community-oriented terms: the percentage of patients within each group who had received the preventive service in the recommended interval. During the study period, adherence to four of the five preventive services increased significantly, with the largest increases in the physician and patient reminder group: cholesterol measurements increased from 19.5% to 38.1%, fecal occult blood testing 9.3% to 27.0%, mammography 11.4% to 27.1%, and tetanus immunization 23.4% to 35.4% (for each increase, P less than .0001, McNemar's chi-square test). In general, increases were greater in blacks and in patients with any form of insurance coverage. Computer-based physician and patient reminder systems have great promise of improving adherence to preventive services in primary care settings.     

Physician practices and attitudes regarding adult immunizations

OBJECTIVES: To assess immunization practices and attitudes of U.S. primary care physicians regarding adult influenza and pneumococcal immunizations. METHODS: Mailed survey of primary care internists and family physicians across the United States; four follow-up contacts by mail and telephone. Bivariate and multivariate analyses assessed immunization practices and attitudes and differences by physician characteristics. RESULTS: Three hundred and sixteen of 668 eligible physicians responded (50 refused, response rate of 266 = 40%); 220 provided adult vaccinations. More than 64% indicated they routinely vaccinated patients >/=65 years and those <65 years with chronic disease indications with both influenza and pneumococcal vaccine. Reported barriers for influenza vaccination included vaccine safety concerns by patients (58%), urgent concerns dominating visits (43%), and inadequate reimbursement (26%). Reported barriers for pneumococcal vaccination included urgent concerns during office visits (44%), no patient immunization history (36%), patient concerns about vaccine safety (31%), and inadequate reimbursement (25%). Many physicians indicated willingness to try tracking systems (72%), chart reminders (55%), patient reminders (53%), standing orders (36%), external lists of unimmunized patients for pneumococcal vaccination (74%), external patient reminders (70%), and office training of physicians (36%) or staff (46%). CONCLUSIONS: While most physicians favored adult vaccinations, practical barriers to vaccination exist. Most physicians would adopt evidence-based strategies to improve immunization delivery.     

Improving influenza vaccination performance in an HMO setting: the use of computer-generated reminders and peer comparison feedback.

We evaluated a program for improving influenza immunization performance in a health maintenance organization (HMO). The HMO implemented several interventions successively from 1984-87: a postcard reminder to members at high risk for complications of influenza, a computer-generated reminder to the physician at the time of any primary care visit by high-risk patients, performance feedback to chiefs of service, and, finally, retrospective feedback to each physician comparing his/her performance with that of the other physicians. We examined immunization rates for a group of members older than age 65, a high-risk group under age 65, and a group of diabetic members who had not been subject to the reminders (vs a group who had been covered by the program). Vaccination rates were increased in those diabetic members who received reminders. Nevertheless, among members younger and older than age 65 whose experience was observed over three flu seasons, a significant increase in vaccination rates was not achieved until physician feedback was added to the program. We conclude that each element of the reminder and feedback program has contributed to the overall increase in vaccination rates at the HMO and that effective ongoing influenza immunization programs can be implemented in practice settings with appropriate systems support.     

The impacts of email reminder/recall on adolescent influenza vaccination

BackgroundWe sought to: (1) explore the feasibility of using email for seasonal influenza vaccination reminders to parents of adolescents and (2) assess influenza vaccination rates among adolescents whose parents were randomized to either receive or not receive email reminders.MethodsEmail addresses were obtained for parents of patients 10–18 years from 4 practices in Michigan. Addresses were randomized to either receive email reminders, or not. Reminder messages were sent during October 2012-March 2013 (Season 1) and October 2013-March 2014 (Season 2). Vaccination status was determined 60 days following the last email reminder for each season using the statewide Michigan Care Improvement Registry (MCIR); per protocol bivariate and multivariate logistic regression analyses were conducted to evaluate reminder notification.ResultsAfter email cleaning, testing, and matching with MCIR, approximately half of email addresses (2348 of 5312 in Season 1; 3457 of 6549 in Season 2) were randomized. Bivariate analyses found that influenza vaccination within 60 days after notification date was similar among those notified (34%) versus not notified (29%) in both Season 1 (p = 0.06) and Season 2 (39% vs. 37%, p = 0.20). However, multivariate models adjusted for season, site, and receipt of notification in two seasons found a higher likelihood of influenza vaccination among children that received notification (aOR = 1.28, 95% CI = 1.09, 1.51); in addition, differences in influenza vaccination were also observed between practice sites (range: p = 0.15 to p < 0.001).ConclusionsWe found that practice-based email influenza vaccine reminders to parents of adolescents are feasible, but not without complications. Our study demonstrates that email reminders from practices can yield increases in influenza vaccination rates among adolescents. Practices should consider email as an option for influenza reminders and establish business practices for collecting and maintaining patient email addresses.This study is registered at www.ClinicalTrials.gov id #NCT01732315.     

The effect of various types of patients’ reminders on the uptake of pneumococcal vaccine in adults: A randomized controlled trial

BackgroundInvasive pneumococcal disease is one of the most important vaccine-preventable diseases threatening the adult community due to missed opportunities for vaccination. This study compares the effect of three different types of patient reminder system on adulthood Streptococcus pneumoniae immunization in a primary care setting.MethodsThe study targeted patients aged 40 and older eligible for pneumococcal vaccine, but did not receive it yet (89.5% of 3072 patients) based on their electronic medical records in a family medicine center in Beirut. The sample population was randomized using an automated computer randomization system into six equal groups, receiving short phone calls, short text messaging system (sms-text) or e-mails each with or without patient education. Each group received three identical reminders spaced by a period of four weeks. Documentation of vaccine administration was then added to the longitudinal electronic patient record. The primary outcome was the vaccine administration rate in the clinics.ResultsOf the eligible patients due for the pneumococcal 23-polyvalent vaccine, 1380 who had mobile phone numbers and e-mails were randomized into six equal intervention groups. The various reminders increased vaccination rate to 14.9%: 16.5% of the short phone calls group, 7.2% of the sms-text group and 5.7% of the e-mail group took the vaccine. The vaccination rate was independent of the age, associated education message and the predisposing condition.ConclusionUse of electronic text reminders via e-mails and mobile phones seems to be a feasible and sustainable model to increase pneumococcal vaccination rates in a primary care center.     

Opinions of family physicians and specialists on vaccination against influenza]

About 50 percent of the patients who because of an underlying disease should be vaccinated annually against influenza, do not receive the vaccine. One of the major reasons is that they are not informed by their physicians about the need to be vaccinated. To understand the attitude of the physicians concerning influenza vaccination and the way the vaccination of these patients is organized, questionnaires were send to 250 general practitioners, 125 cardiologists and 125 pulmonologists in the Netherlands. Eighty-four percent of the questionnaires were returned. The results show that the physicians were well informed about the indications for vaccination. A minority of the physicians had doubts about the efficacy of the vaccine. Both specialists and general practitioners agreed that vaccination should be performed by the general practitioner. Instruction of the patients and application of the vaccine were generally rather well organized. It is to be expected, however, that improvement of the organization will enhance the rate of vaccination against influenza in the Netherlands.     

Improving preventive care at a medical clinic: how can the patient help?

We developed a comprehensive individualized preventive care reminder system and then tested the hypothesis that directly involving patients in the reminder process would lead to greater use of preventive services than involving physicians only. There were three experimental groups of 350 patients each: in group 1 physicians and patients received the reminder; in group 2 physicians only received the reminder; in group 3 neither physicians nor patients received the reminder. Nine preventive care services were studied: blood pressure measurement; dental exam; ocular pressure measurement; stool exam for occult blood; influenza, pneumococcal, and tetanus vaccinations; mammography; and Papanicolaou smears. Need for these services was determined by telephone interview and chart review. To determine whether services were obtained, charts were reviewed after four to eight months of follow-up. For overall compliance with preventive recommendations and for several individual services (stool exam for occult blood, tetanus vaccination, mammography), group 1 patients received significantly more preventive care than group 2. Likewise, group 2 patients received more preventive care than group 3. These data show that involving patients in reminder efforts is an effective means of raising the level of preventive services.     

Effect of mobile phone text messaging for improving the uptake of influenza vaccination in patients with rare diseases

ObjectivesInfluenza vaccine is recommended in some chronic medical conditions, including several rare diseases. The objectives of the study were to assess the effect of text message reminders on influenza vaccination uptake of patients with selected rare diseases and delayed vaccination, and to describe their characteristics.MethodsQuasi-experimental pre-post intervention study performed along the 2016 influenza vaccination campaign in the Autonomous Community of Madrid. Unvaccinated patients diagnosed with a selected rare disease were targeted for intervention. SMS were sent to them at least one month after the beginning of the campaign, in four consecutive weeks. Those with no mobile phones available or no certainty of message reception, were assigned as controls. The association between the reception of the SMS and vaccination uptake was assessed using multiple poisson regression models.ResultsOf 69.040 patients with delayed vaccination, 87.2% received an SMS reminder in the asigned contact mobile telephone. Global influenza vaccine coverage reached 41.3%. The uptake of influenza vaccine was significantly higher among those receiving the reminder (9.3% vs. 7.1% in the control group, p < 0.001). Those who received a SMS reminder were 30% more likely to uptake seasonal influenza vaccine. By sex and age, the reception of the reminder was associated with a significantly higher probability of vaccination in men ≥65 years with at least a concurrent chronic condition (IRR: 1.58, CI95%: 1.25–2.00). Among women, this higher probability was detected in those between 14 and 64 years of age (IRR: 1.41, CI95%: 1.22–1.63), and ≥65 years without concurrent chronic conditions (IRR: 1.40, CI95%: 1.05–1.89).ConclusionAlthough the intervention was modestly effective, it proved beneficial in some cases. It can be an additional strategy to improve vaccine uptake, since it is simple, feasible, affordable and easily scalable, particularly when immunization and target population data are available in population registries.     

Assessing influenza vaccine utilization in physician offices serving adult patients: experience during a season of vaccine delays and shortages.

BACKGROUND: Influenza vaccination among US adults has plateaued at suboptimal levels. Severe delays and shortages of influenza vaccine prompted revised guidances to prioritize vaccine first to persons at greatest risk for serious influenza complications and to create vaccine stockpiles. OBJECTIVES: (1) Pilot an assessment of influenza vaccine use in a large sample of physician offices with adult patients. (2) Apply the method to assess vaccine receipt by age and risk groups. METHODS: Influenza vaccination and risk status for the 2000-2001 season were obtained from record review conducted in November 2001 to April 2002 for adult patients in a sample of physicians' offices in eight states. Participating physicians also completed a questionnaire. RESULTS: The assessment method was feasible to implement. One hundred eighteen physicians participated. They administered more than 83 percent of doses to prioritized groups in October and November compared with 74 percent of doses during the entire season. Office-based vaccination coverage was less than 40 percent in all age and risk groups. More than 50 percent of participating physicians reported unused doses. CONCLUSIONS: Office-based assessments of vaccine utilization can be a valuable evaluation tool. Vaccine distribution was consistent with recommendations to target early vaccination to priority groups. Results highlight the difficulty distributing vaccine late in the season and the need for strategies to improve vaccination coverage, particularly when vaccine supply is inadequate.     

Provider attitudes regarding use of an immunization information system to identify children with asthma for influenza vaccination.

OBJECTIVES: Despite longstanding national guidelines, many children with asthma do not receive annual influenza vaccinations. Information from Medicaid-administrative claims data was integrated into the Michigan Care Improvement Registry (MCIR) to prompt providers regarding influenza vaccination among children with high-risk conditions such as asthma. The attitudes of pediatric primary care providers regarding the implementation of this system were assessed. METHODS: A survey was sent in February 2006 to office-based general pediatricians (n = 300) and family physicians (n = 300) in Michigan. The survey focused on influenza vaccination during the 2005-2006 influenza season and attitudes regarding a reminder system for providers using the MCIR. RESULTS: Overall response rate was 67 percent. MCIR participation was high (91%) among respondents, and most (83%) had MCIR information available to them prior to visits with pediatric patients. Most physicians (75%) considered the MCIR high-risk indicator for influenza vaccination a feature that they would find helpful. Some respondents reported concerns that the reminder system is limited to Medicaid patients only (44%) and regarding the completeness of Medicaid data to identify children with asthma (24%). CONCLUSIONS: Physicians have a positive overall view of a statewide registry-based automated reminder system to assist in identifying children with asthma for influenza vaccination, albeit with specific areas of concern.     

Public health in managed care: a randomized controlled trial of the effectiveness of postcard reminders.

OBJECTIVES: This study evaluated the effectiveness of an annual public health intervention in a managed care setting. METHODS: Managed care organization members 65 years and older who received influenza immunization in 1996 were randomized to an intervention group (mailed a postcard reminder to receive an influenza vaccination in 1997) or a control group (no postcard). Vaccination rates for both groups were assessed monthly. RESULTS: Members receiving the intervention were no more likely to be immunized (78.6%) than members of the control group (77.2%, P = .222). Members were vaccinated at the same pace regardless of vaccination history and postcard intervention status. CONCLUSIONS: Postcard reminders were not an effective intervention among seniors who had been vaccinated the previous year.     

Determinants of influenza vaccination coverage rates among primary care patients in Krakow,Poland and the surrounding region

ObjectivePoland is significantly behind other European countries in terms of influenza vaccination coverage. In addition, the vaccination rate among health care personnel in Poland is also very low. The aim of this study was to determine the current barriers to achieving effective influenza vaccination coverage among primary health care (PHC) patients and physicians in Poland and to reveal any associations between the patients’ and physicians’ characteristics and the influenza vaccination coverage rate among patients.MethodA cross-sectional questionnaire-based survey was distributed among 18 PHC physicians and 533 their patients in Krakow, Poland and the surrounding region. The data from patients were associated with the doctors’ characteristics.ResultsThe reasons for not receiving the influenza vaccine differed between patients and their physicians. Among the patient population, the main reason behind vaccination non-compliance was the self-perception of good health, while forgetting about the vaccination was the main reason among the physicians.The factors that had the positive influence on the patients’ decision to receive the vaccination involved: older age, being a widower, being retired, having a chronic disease, being vaccinated against influenza in the past and awareness of influenza complications. Moreover, those patients who had received sufficient influenza vaccination education from their healthcare provider and had been the patients of physicians who had been vaccinated against influenza, had significantly higher vaccination rates.ConclusionImproved patients and doctors education strategies are needed to maximize influenza vaccination coverage rates. Information regarding the need and benefits of the influenza vaccine, along with details on where and when to receive vaccination will provide a positive influence on a patients’ decision-making process regarding vaccination compliance. Also, the free of charge influenza vaccinations for all primary health care workers should be considered.     

National availability of influenza vaccine among medical subspecialty practices

BACKGROUND: Influenza vaccination rates fall short of national goals, particularly among individuals whose chronic conditions predispose them to complications of influenza. Availability of influenza vaccine in medical subspecialists' practices may affect vaccination rates among adults with chronic illness. METHODS: The practice sites of a national random sample of medical cardiology, endocrinology, and pulmonology physicians were contacted by telephone in February 2003 to March 2003 to determine which of them had influenza vaccine available to their patients during the 2002-2003 influenza season. The number of physicians in the practice and geographic location were also obtained. RESULTS: Office staff at the practices of 1683 of 2013 eligible physicians were successfully contacted, and 1473 provided information about vaccine availability. Overall, 1094 (74%) of practices had influenza vaccine available during the 2002-2003 season. Availability differed significantly by subspecialty: 54% cardiology, 78% endocrinology, and 90% pulmonology (p<0.001). Influenza vaccine was more often available at subspecialists' practices in the Northeast (80%) than in the South (74%), Midwest (71%), and West (70%; p<0.005). In multivariate analyses, pulmonology practices in all census regions and sizes were significantly more likely to have influenza vaccine available than was the reference cardiology practice. Several endocrinology practice types also had significantly higher influenza vaccine availability than those in cardiology practice, particularly in multi-physician practices. CONCLUSIONS: Influenza vaccine availability varies widely across practices in the three medical subspecialties that provide care to the largest numbers of individuals with an indication for the vaccine in the United States. These findings have implications for the accessibility of influenza vaccine to individuals at high risk for morbidity and mortality associated with influenza.     

Why is influenza vaccine uptake so low among Aboriginal adults?

Objectives: Determine major barriers to, and facilitators of, influenza vaccination of Aboriginal adults, in order to improve coverage from the current level of 30%. Methods: i) A focus group with 13 Aboriginal Immunisation Healthcare Workers; and ii) a cross‐sectional survey of Aboriginal people aged ≥18 years at the 2017 New South Wales Koori Knockout (29 September–2 October). Results: The focus group nominated poor identification of Aboriginality in general practice. Of 273 survey respondents, a substantial minority (30%) were unaware of their eligibility for free influenza vaccination. More than half (52%) believed the vaccine could cause influenza, 40% reported there were better ways than vaccination for avoiding infection and 30% said they would not have the vaccine if it was offered to them. Regarding health service access, few reported experiencing difficulty (17%), feeling uncomfortable (15%) or being discriminated against (8%), but 53% reported not receiving a reminder from a health professional. Conclusions: Misconceptions about influenza disease and vaccine among Aboriginal people and inadequate identification of Aboriginality in general practice appear to be the greatest barriers to vaccination, rather than health service access in general. Implications for public health: More active communication to and targeting of Aboriginal adults is required; this is even more urgent following the arrival of COVID‐19.