Evaluating Awareness of Pneumococcal Vaccination Among Adults 65 Years Old and Above Attending a SingHealth Polyclinic A Community Health Study

Transcription

1 Evaluating Awareness of Pneumococcal Vaccination Among Adults 65 Years Old and Above Attending a SingHealth Polyclinic A Community Health Study Goh Zhaojing and Suriya Prakaash SingHealth Family Medicine Residency (2016) 6 th APPCRC, 22 Sep 2017

2 Contents 1. Introduction: Topic selection and study objectives 2. Background: Pneumococcal disease and vaccination 3. Methodology 4. Results 5. Discussion update: Adult pneumococcal vaccination in Singapore 7. Conclusion

3 Introduction

4 1. Introduction: CHP Community Health Project 9 Family Medicine residents, Year 2 of SingHealth FM residency (2015) Topic: Pneumococcal vaccination awareness Study population: Adults 65yo in a primary care setting Project aims: (1) Data gathering survey; (2) Health education

5 1. Introduction: Topic selection Adults aged 65 years old are at high risk of morbidity and mortality from invasive pneumococcal disease caused by encapsulated strains of Streptococcus pneumoniae. Pneumococcal vaccination for the prevention of serious pneumococcal infection is available in Singapore. Topic relevance: 1) Aging population + chronic diseases 2) Pneumonia: among top 3 principal causes of death 3) Role for primary care physicians in preventive care

6 1. Introduction: Study Objectives 1) Investigate older adults awareness and knowledge of pneumococcal vaccination. 2) Identify factors affecting vaccination uptake. 3) Raise awareness of pneumococcal vaccination

7 2. Background Pneumococcal disease 2.1 Invasive pneumococcal disease 2.2 Prevalence and disease burden Pneumococcal vaccination 2.3 Pneumococcal vaccines 2.4 Pneumococcal vaccination in Singapore

8 2.1 Invasive pneumococcal disease

9 2.2 Prevalence and disease burden Reference: Low S, Chan FLF, Cutter J, Ma S, Goh KT, Chew SK. A national study of the epidemiology of pneumococcal disease among hospitalised patients in Singapore: 1995 to Singapore Med J 2007; 48(9):

10 2.3 Pneumococcal vaccines PCV13 (e.g. Prevnar 13, Pfizer) 13-valent conjugate vaccine T-cell-dependent response improved immunogenicity 75% efficacy against vaccine-type IPD among adults 65y PPSV 23 (e.g. Pneumovax 23, MSD) 23-valent polysaccharide vaccine 60-70% efficacy in preventing IPD

11 2.3 Pneumococcal vaccines PCV 13 (e.g. Prevnar 13) PPSV 23 (e.g. Pneumovax 23) Minimum age 6 weeks onwards 2 years onwards Younger children Older children (6y-18y) Adults (19y-64y) 3 months to 5 years All (regardless of immune status) Special populations* (* Cochlear implant, CSF leak, asplenia, HIV) Special populations (* as above + other immunocompromise conditions) Older adults ( 65y) All All 2-5y, at risk of pneumococcal disease As for PCV + those with chronic disease (chronic heart/ lung/ liver/ diabetes) As for PCV + those with chronic diseases Reference:

12 2.4 Pneumococcal vaccination in Singapore Adult pneumococcal vaccination Local data on vaccination rates for adults lacking Institutional practice (SHP, 2015) Routine pneumococcal vaccination: Young children (typically 2y) PCV13 (Prevnar 13) Older adults (typically 65y) PPSV23 (Pneuovax 23)

13 Methodology

14 3. Methodology 3.1 Project overview 3.2 Study design 3.3 Survey questionnaire 3.4 Patient education 3.5 Survey execution

15 3.1 Project overview Project workflow 1) Topic selection 2) Study design 3) Survey planning and execution 4) Data analysis Organisations involved SingHealth Polyclinics (Dept of Research; Sengkang Polyclinic) MSD Singapore (sponsorship of materials)

16 3.2 Study design 1) Literature search Local data on adult pneumococcal vaccination 2) Defining study aims a) Research questions Investigate awareness and knowledge Understand factors affecting decision for vaccination uptake b) Patient education Influence of short education segment Raise awareness

17 3.2 Study design 3) Defining the study population Adults aged 65yo in 2015 Sengkang polyclinic patients AND non-patients 200 respondents Mental capacity 4) Formulation of questionnaire

18 3.3 Survey questionnaire Questionnaire design English and Chinese versions Three sections A. Demographic information B. Pre-existing patient knowledge -Education Segment- C. Patient response

19 3.3 Questionnaire: English

20 3.3 Questionnaire: English

21 3.3 Questionnaire: Chinese ( 中文版 )

22 3.3 Questionnaire: Chinese ( 中文版 )

23 3.4 Patient education 5 minute segment during survey Administered by surveyor Educational materials Pamphlets Posters

24 3.4 Information pamphlet (English)

25 3.4 Information pamphlet (Chinese)

26 3.5 Survey execution When 15 and 16 June 2015 (Mon/Tue) Clinic operating hours (7.30am-5.00pm) Where Who How Sengkang Polyclinic Surveyors: All nine CHRP project group members Respondents: Adults 65 years of age in 2015 at SK polyclinic on days of survey Project workflow

27 3.5 Survey execution Patient 65yo Registration Agreeable? Waiting Area Family 65yo Yes No Survey + Education Keen for vaccine? No Yes End Appointment

28 Results and discussion

29 4. Results A. Demographic information 262 respondents 125 (47.7%) males Median age: 71 (age range: years) Indian (12) 4% Race Other (5) 2% No formal edu (52) 20% Highest education level Malay (23) 9% Tertiary (14) 5% Primary (99) 38% Chinese (222) 85% Secondary (97) 37%

30 4. Results A. Demographic information (con d) Current smoker (29) 11% Smoking status Hospital (22) 8% Chronic conditions follow-up None (29) 11% Ex-smoker (48) 18% Never smoked (185) 71% GP (9) 3% Polyclinic (216) 78%

31 4. Results Chronic medical conditions Diabetes (97) 37 COPD (2) Asthma (19) Hypertension (185) 70.6 IHD (35) CKD (4) % of all respondents Others (102) 38.9 None (29) % 20% 40% 60% 80% 100%

32 4. Results Had pneumococcal vaccination before? 1. Yes 6 (2.3%) 2. No 233 (88.9%) 3. Don t know 23 (8.8%)

33 4. Results B. Pre-existing knowledge Purpose of vaccine? 35 Heard of vaccine before? 1. Yes 70 (26.7%) 2. No 192 (73.3%) Prevent bacterial Infection Reduce risk of infection Treat infection Unsure

34 4. Results Where did you hear of vaccine?

35 4. Results Cost of vaccine? Free < $100 $100-$200 Don't know

36 4. Results C. Attitudes towards vaccination (Pre-education, for respondents aware of vaccination, n=70) Intend to get vaccinated? (Post-education, all respondents) Intend to get vaccinated? Maybe (41) 16% No (42) 60% Yes (28) 40% No (34) 13% Yes (187) 71%

37 4. Results Intention to get vaccinated - If not, or considering, why? No. Don't think I'm at risk. 22 Discuss with family / children. 8 Already old / Let nature take its course. 8 Needle / doctor-phobia 7 Don't think vaccine is useful. 6 Need time to think. 5 Would like more information about vaccine safety and efficacy. 4 Don't think vaccine is safe. 2 Too expensive / Not enough money. 2 Wish to seek other medical opinion. 2

38 5. Discussion Study findings Low vaccination rates among elderly Education improves uptake rates False sense of invulnerability

39 5. Discussion How our study could be improved Survey population: Conducting survey in more than one polyclinic Larger sample size Education segment: Enhance uniformity in delivery of education segment (e.g. scripted, timed) Assessment of effectiveness: Post-education knowledge testing Introduction of control arm

40 5. Discussion Recommendations Need for clinical guidelines for local practice Raise adult vaccination awareness Enhance financial support

41 Updates and conclusions

42 Update Clinical Clinical Practice Guidelines on Adult Vaccination in Singapore (1st Ed, 2016) Updated pneumococcal vaccination guidelines Expanded indications Double vaccination (PCV13 + PPSV23) Practical Vaccine subsidies for adult pneumococcal vaccine PPSV23 is Medisave-claimable for adults 65

43 7. Conclusions and learning points Practical reminders Recommended routine adult vaccinations Influenza (annual) Pneumococcal * Varicella/Zoster * All adults 65y should receive 1 dose PCV 13 followed by PPSV23 * Adults with chronic disease (e.g. asthma, COPD, DM) or with certain immunocompromise conditions may require additional dose(s) of PPSV23 after 65y

44 7. Conclusions and learning points Challenges for adult vaccination Lack of awareness Prioritisation of medical management over preventive care Benefits (perceived and actual) vs burdens (financial) Next steps Education patients, public, healthcare providers Practice incorporate vaccine recommendations as part of routine chronic disease and well-adult care Evaluation vaccination cost-effectiveness

45 8. Acknowledgements SingHealth Family Medicine Residency Dr Sally Ho (Program Director) Dr Lee Cia Sin (Project supervisor) Our preceptors, FM residency faculty, and program executives Sengkang Polyclinic Staff and patients MSD Singapore

46 Group Members Suriya Prakaash Goh Zhaojing Fok Yu Ting (Rachel) Jacquelyn Melody Lim Chong Soon Daniel Lim Sze Wern Liu Sha Virgina Hartono Wu Hang

47 Thank you