PART A - FOR ALL GPs TO COMPLETE
1) Since 1999, free influenza and pnuemococcal vaccine has been available for Aboriginal and Torres Strait
Islanders adults in recommended age and risk groups.
Please indicate if you agree with the following statements in relation to this package. (Please circle one
number in each line).
Yes
No
Unsure
a) I feel I have been provided with sufficient information about age
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and risk group eligibility
b) I feel I have been provided with sufficient information about how to
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obtain free vaccine
2) An information package and posters on influenza and pneumococcal immunisation for Aboriginal and
Torres Strait Islander adults was mailed out to all GP Practices enrolled in the GPII earlier this year.
The posters have photos of well-known Aboriginal and Torres Strait Islander adult personalities on
them.
a)
b)
c)
d)
Please indicate if you agree with the following statements in relation to this package. (Please circle one
number in each line).
Yes
No
Unsure
My practice received the information package and posters.
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The poster was displayed in the waiting room.
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I remember reading the GP information sheet.
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The information on the GP information sheet was useful for me.
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Comments ___________________________________________________________________
3) There were local activities promoting influenza and pneumococcal immunisation for Aboriginal and
Torres Strait Islander adults run in some areas in 2003.
Yes
No Unsure
a) I am aware of local promotion in my area
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If you answered yes , please indicate if you agree with any of the following statements
Yes
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No
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b) Radio announcements were effective in raising awareness.
c) Written materials were effective in raising awareness
d) I am aware of some other local promotional activities.
(Please specify these other activities below.)
e) I found the local activities useful.
Unsure
Comments ___________________________________________________________________
3) Please specify the groups of Aboriginal and Torres Strait Islander adults you understand are eligible for
FREE Influenza and Pneumococcal vaccine? (Please circle one number in each line).
Risk Group
a)
b)
c)
d)
e)
All 15+ years of age
All 65+ years of age
All 50 + years of age
Only with risk factors, 15 – 64 years
Only with risk factors, 15 – 49 years
Statistical Clearing House Approval Number XXXX
Yes
No
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1
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Unsure
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4). Which of the following are considered to be risk factors for Influenza and Pneumoccocal disease in
Aboriginal and Torres Strait Islander adults? (Please tick as many as necessary)
 Diabetes
 Chronic lung disease
 HIV/AIDS
Heavy drinking
 Mild asthma
 Cancer
 Chronic kidney disease
 Smoking
 Immunosuppresive therapy
 Chronic heart disease
Gastic Ulcer Disease
 None of the above
 Other (please specify) _____________________________________________________________
5). How often should at-risk patients receive pneumococcal vaccine? (Please tick appropiate box(es)).
Once only
a) Every year
b) Every 5 years
c) Revaccinate once only, 5 years after the first dose
d) Other (please specify) ______________________
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



6). Which of the following statements about identifying Aboriginal and Torres Strait Islander adults apply in
your practice? (Please circle one number in each line).
Yes
No
Unsure
a) I routinely ask all patients at the beginning of the consultation
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b) Patients usually self identify their status
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c) I ask them only when I think that they might be Indigenous.
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d) It is a part of the registration procedure for new patients at reception
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e) Only for regular patients
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f) Aboriginal and Torres Strait Islander status is not usually asked
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g) Other (please specify) __________________________________________________________
7). Which of the following statements do you agree with ? (Please circle one number in each line).
Agree
Disagree
a) I don’t think Aboriginal and Torres Strait Islander status is relevant
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2
b) I find the question difficult to ask
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c) I don’t see Aboriginal and Torres Strait Islander patients in my practice
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d) Other (please specify) __________________________________________________________
Unsure
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8). Did you see any Aboriginal and Torres Strait Islander patients in 2003?
(Please circle one)
Yes / No / Unknown
If your answer is NO or UNKNOWN then please go to Question 9. If YES, please proceed to question 11 in
Part B of the survey.
9). How many GPs work in your practice? ______________
10). Please provide an estimate of the time taken to complete this form. Include:
 The time actually spent reading the instructions, working on the question and obtaining the information
 The time spent by all employees in collecting and providing this information
Minutes________
THANK YOU FOR YOUR PARTICIPATION. PLEASE RETURN YOUR COMPLETED
SURVEY IN THE REPLY PAID ENVELOPE SUPPLIED OR BY FAX TO (02) 9845 3082
AS SOON AS POSSIBLE.
Statistical Clearing House Approval Number XXXX
2
PART B. - FOR GPS WITH ABORIGINAL AND TORRES STRAIT ISLANDER PATIENTS ONLY
11). Have you encountered any of the following barriers in providing vaccination services for Aboriginal
and Torres Strait Islander adults in your practice?
Yes
No
Unsure
a) Difficulty in determining Aboriginal and Torres Strait Islander status
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b) Infrequent/irregular attenders
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c) Difficulty with pressure of routine work
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d) Difficulty in accessing vaccine supplies
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e) Cultural or other barriers (please specify) _______________________________________________________
_______________________________________________________________________________________
12). Did you immunise any Aboriginal and Torres Strait Islander adults this year for influenza or
pneumococcal infection? (Please circle) Yes / No
IF YOU ANSWERED YES TO QUESTION 12 PLEASE PROCEED TO QUESTION 13. IF YOU
ANSWERED NO TO QUESTION 12, PLEASE NOW PROCEED TO Q25 AT THE END OF THE
SURVEY.
13). Which of the following statements do you agree with ? (Please circle one number in each line).
Yes
No
Unsure
a) The information pack and posters
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were important in prompting immunisation .
b) Local promotional activities were important in prompting immunisation .
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c) My practice has taken measures to promote immunisation.
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d) My practice has collaborative arrangements with
a local Aboriginal Community Controlled Health Organisation
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e) My practice has collaborative arrangements with a
State-funded service provider
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14). Which educational materials or activities have you found to be most successful in promoting
vaccination of Aboriginal and Torres Strait Islander adults? __________________________________
______________________________________________________________________________________
15). In what settings have you vaccinated Aboriginal and Torres Strait Islander adults in this year?
(Please tick one or more)
Some Most All
a) Private practice.



b) Aboriginal community controlled health organisation



c) Other



d) Please specify “other” type ____________________________________________________
16). Please indicate which of the following approaches have been important in promoting vaccination of
Aboriginal and Torres Strait Islander adults in your practice this year : (Please circle one in each
line).
Yes
No
Unsure
a). Direct Patient request
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b). My recommendation during consultation
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c). Recall / reminder system
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d). Community outreach program
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e). Other. Please specify _____________________________________________________________________
Statistical Clearing House Approval Number XXXX
3
17). Please indicate which of the following are used in your practice to record and report vaccination of
Aboriginal and Torres Strait Islander people: (Please tick one or more)






Patient medical records (paper)
Patient medical records (computerised). Please specify software _________________________
Patient immunisation register (computerised)
Patient immunisation register (paper-based)
Vaccine order / acquittal form
Other. Please specify ___________________________________________________________
18). Given the information system in your practice, providing details on each vaccine administered by
patient age and risk group would be: (Please circle one only)
easy / not difficult / fairly difficult / very difficult
If difficult, please give reasons ______________________________________________________________
19). Please indicate what measures would significantly improve your ability to provide data on each
vaccine administered in your practice: (Please circle one number in each line).
Yes
No
Unsure
Improved practice software
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Web-based reporting
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Feedback / information from local health authorities
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Payment for each report
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Other. Please specify _____________________________________________________
20). Please estimate the numbers of each of the following vaccines given by you to Aboriginal and Torres
Strait Islander adult patients in 2003: (Please tick one or more)
0-10 10-20 20-30 30+ (If >30 Please estimate number)
Pneumococcal
15-49 years
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
_____
Pneumococcal
50+ years
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

_____
Influenza
15-49 years
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

_____
Influenza
50+ years




_____
21). Have you encountered any problems related to free supply of vaccine this year? (Please circle)
Yes / No If yes, please specify_____________________________________________________________
22). Were any vaccines for Aboriginal and Torres Strait Islander adults also accessed in other ways apart
from the free supply ordered from your local State or Territory Department of Health? (Please tick )
 No
 Yes, prescription
 Yes, other (please specify) _________________________________________________________
23). Any other comments or suggestions regarding the program.______________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
24). How many GPs work in your practice? ______________
25). Please provide an estimate of the time taken to complete this form. Include:
 The time actually spent reading the instructions, working on the question and obtaining the information
 The time spent by all employees in collecting and providing this information
Minutes________
Statistical Clearing House Approval Number XXXX
4
THANK YOU FOR YOUR PARTICIPATION. PLEASE RETURN YOUR COMPLETED SURVEY
IN THE REPLY PAID ENVELOP SUPPLIED OR BY FAX TO (02) 9845 3082 AS SOON AS
POSSIBLE.
Statistical Clearing House Approval Number XXXX
5