[Tetanus vaccination in adults: the situation in primary care].

OBJECTIVE

To describe the strategies adopted to increase anti-tetanus vaccination coverage in people over 24, as well as the record systems which exist in Castilla-La Mancha health centres. In addition, to determine those factors involved in achieving greater coverage which depend on the primary care team (PCT).

DESIGN

An observational study of a crossover type.

SETTING

Primary care.

PARTICIPANTS

The PCT in Castilla-La Mancha existing in 1993. 72.5% reply rate.

MEASUREMENTS AND MAIN RESULTS

The average coverage achieved, weighted according to population, was 10.55%. The main risk groups in which strategies to increase coverage were put into practice were: the chronically ill (49.5%), professionals at risk (37.6%) and pregnant women (32.6%). Patients were summoned for follow-up doses by 41.3% of PCTs as a matter of habit and by 41.3% occasionally. Normally the vaccination was recorded in the Medical Notes by 41.9% of PCTs. A linear tendency between a higher vaccination rate and, on the other hand, both greater insistence that patients attend for revaccination (p = 0.01) and better recording in the medical notes (p = 0.04) was confirmed. Vaccination coverage was significantly greater in health centres where less people were seen (p < 0.001) and which were more modern (p = 0.003).

CONCLUSIONS

The low anti-tetanus vaccination coverage found justifies setting up initiatives of demonstrated efficacy to increase anti-tetanus immunisation. Better records and insistence on patients' attendance for follow-up doses are factors linked to greater vaccination coverage.