do better? McGovern EM, Reid J and Ahmed S

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2 Seasonal Flu Vaccine uptake in at risk population: Can we do better? McGovern EM, Reid J and Ahmed S Acknowledgements: Participating GP practices, Adebola Elizabeth Adebayo, Kathryn McCrindle, University of Strathclyde

3 Background Vaccination for those at clinical i l risk >65y, pregnant women, chronic disease, healthcare workers, carers, obesity Target 75% uptake challenging Uptake in at risk in NHSGGC below 60% last 3 seasons NICE review of review level evidence 2013 and ECDC barriers and drivers 2013 Self audit tool developed for GP practices

4 Aim To evaluate usefulness of a self audit tool and feedback report to GP practices on flu vaccine uptake BMJ May pdf+html ECDP influenza-vaccination-drivers-barriers.pdf

5 Methods 60 GP practices with representative uptake invited to participate Self audit tool completed by practices against 24 criteria Personnel, documentation, invite/recall, administration, post campaign activities Seasonal Flu Immunisation Audit Please see below for seasonal flu uptake for 2014/15 Practice (xxxx) HSCP Average Over 65 years 69.4% 75.6% 75.9% < 65 years in clinical at risk 40.5% 53.6% 54.3% Chronic respiratory disease 36.4% 52.6% Chronic heart disease 44.1% 57.9% Chronic renal disease 38.7% 64.6% Chronic liver disease 37.9% 49.0% Chronic neurological disease 46.3% 54.9% Diabetes 57.2% 69.1% Immunosuppression (exc. Asplenia) 53.8% 64.4% Carers 46.2% 57.5% Asplenia or dysfunction of the spleen 10.0% 44.8% NHS GGC Average Pregnant (no other risk factors) 50.0% 54.7% 55.1% Pregnant (plus other risk factors) 25.0% 64.9% 69.2% Pre-school children (2-5years) 53.2% 46.1% 55.4% Criteria Yes No Details Section 1: Personnel 1.1 Is there a lead member of staff responsible for running the vaccination campaign, a flu champion? 1.2 Is there a lead member of staff responsible for identification of eligible patients?

6 Methods cont Practices receive individualized feedback report on compliance and recommendations for improvement Participate in one to one interviews May/June 2015 Compare vaccine uptake for 2014/15 and 2015/16 flu seasons for intervention and matched controls Feedback Report of GP Practice Seasonal Flu Immunisation Self-Audit Practice: Practice code: Date of Audit /Completed by: Feedback report completed by / date: KEY RESULTS xxxxx xxxxx xxxxx 24 th June 2015 / xxx xxx, Practice Manager Adebola Elizabeth Adebayo, MSc Clinical Pharmacy Student, University of Strathclyde / 26 th June 2015 Elderly (> 65 years and above): 69.4% At risk groups (< 65 years): 40.5% Chronic renal disease: 38.7% (n=20) SUMMARY Many areas of exemplary practice including having a flu champion, review of vaccine remaining in fridge and running searches to identify newly eligible. Your practice achieved poor uptake rate for pregnant women with risk factors and those under 65years in a clinical risk group, in particular.. RECOMMENDATIONS Collaboration Collaborate with others e.g. pharmacists, community midwives, carers associations and patient support groups. Learn from other general practices in local area with higher uptake. Operational Encourage more of own staff to accept immunisation. Having staff with pro-immunisation attitude may encourage patient response to acceptance. Send reminders to all eligible patients. Noticeably, practice achieved lower uptake rates amongst those that do not receive reminders compared to those that do. Organisational Develop a mechanism to read code patients recommended for flu immunisation by secondary care. Post vaccination campaign Share report highlighting what worked well and areas for potential improvement, developing action plan to help guide improvements.

7 Results : Self audit Completed by 11 GP practices 2 high, 4 medium, 5 low uptake Overall compliance against criteria i reasonable (58-86%) 86%) Except Allocating additional staff/funding, collaboration with DN, CP, weekend/eve clinics, written report, inviting feedback

8 Results: Feedback report Main areas for improvement Collaboration, sharing report, learning from higher uptake, involving stakeholders 4 10 recommendations per practice % vaccine uptake 80% 70% 60% 50% 40% 30% 20% 10% 0% , , Individual practices with number of recommendations made in feedback report. Note: number of patients in eligible cohort shown above each Practice. 237

9 Results : Interviews 9 practice managers, all believed self audit and feedback useful I think the audit made me think about it again and look at it with fresh eyes...we don t always have time... we have so many things coming in so having it individualized down and showing the average and how we performed in the year before instead of having to pull out different figures is a lot easier to see how well we are doing and what we need to improve If patients don t want to come in. I mean in saying that, even our staff don t want the flu jab either.

10 Under 65 years in at risk category Season 14/15 15/16 Median (IQR) uptake in 46.1 (15.9) % 50.1 (16.8) % P= intervention practices Median (IQR) uptake in (15.1) 1) % 41.6 (18.1) 1) % P< control practices Note: provisional data suggested that vaccine uptake overall for Scotland, 6.6% down for at risk patients. Over 65 years Season 14/15 15/16 Median (IQR) uptake in intervention practices 72.4 (9.1) % 69.7 (7.1) % P=0.091 Median (IQR) uptake in 72.3 (11.1) 1) % (12.2) 2) % P= control practices Note :provisional data suggested that vaccine uptake overall for Scotland,5 years 2.4% down for over 65 years

11 Feedback Report of GP Practice Seasonal Flu Immunisation Self-Audit Practice: Practice code: Date of Audit /Completed by: Feedback report completed by / date: KEY RESULTS xxxxx xxxxx xxxxx 24 th June 2015 / xxx xxx, Practice Manager Adebola Elizabeth Adebayo, MSc Clinical Pharmacy Student, Ui Universityit of Strathclyde th / 26 th June 2015 Elderly (> 65 years and above): 69.4% At risk groups (< 65 years): 40.5% Chronic renal disease: 38.7% (n=20) SUMMARY Many areas of exemplary practice including having a flu champion, review of vaccine remaining in fridge and running searches to identify newly eligible. Your practice achieved poor uptake rate for pregnant women with risk factors and those under 65years in a clinical risk group, in particular.. RECOMMENDATIONS Collaboration Collaborate with others e.g. pharmacists, community midwives, carers associations and patient support groups. Learn from other general practices in local area with higher uptake. Operational Encourage more of own staff ffto accept immunisation. i Having staff with pro-immunisation i attitude may encourage patient t response to acceptance. Send reminders to all eligible patients. Noticeably, practice achieved lower uptake rates amongst those that do not receive reminders compared to those that do. Organisational Develop a mechanism to read code patients recommended for flu immunisation by secondary care. Post vaccination campaign Share report highlighting what worked well and areas for potential improvement, developing action plan to help guide improvements.

12 40.5% Elderly ( 65) 69.4% All at Risk (<65) Each group is displayed alongside its percentage uptake. Target uptake: 75% 35.7% Healthy Pregnant Women Carers 32.5% Chronic Liver Disease 42.7% Chronic Heart Disease 44.1%

13 SUMMARY Many areas of exemplary practice including having a flu champion, review of vaccine remaining in fridge and running searches to identify newly eligible patients. Your practice achieved poor uptake rate for pregnant women with risk factors and those under 65years in a clinical risk group, in particular Asplenia/ dysfunction of the spleen Chronic renal disease Chronic respiratory disease Chronic heart disease RECOMMENDATIONS Collaboration Collaborate with others e.g. pharmacists, community midwives, carers associations and patient support groups. Learn from other general practices in local area with higher uptake. Involve all practice staff and stakeholders in campaign planning. Operational Organisational Review opportunities for out of hours access to flu clinics. Encourage more of own staff to accept immunisation. Having staff with pro immunisation attitude may encourage patient response to acceptance. Send reminders to all eligible patients. Noticeably, practice achieved lower uptake rates amongst those who do not receive reminders compared to those who do. Review current levels of staff time/funding to ensure sufficient to successfully deliver campaign. Develop a mechanism to read code patients recommended for flu immunisation by secondary care.

14 Discussion Self audit acceptable Feedback report welcomed by all practices Only provided to practice manager but potential to share more widely Original feedback report used poor quality infographics Small pilot project Conclusion Self audit with feedback was welcomed by practices. This small pilot project showed encouraging results for those under 65 years in clinical at risk categories and worthy of further scale up