Quick Reference Guide CAT4. Adult Immunisation

Transcription

1 Quick Reference Guide CAT4 Adult Immunisation <4.0> - June 2015

2 Organisation Contacts Sydney Office Pen CS Level 1, 35 Moore St LEICHHARDT NSW 2040 Phone: + 61 (0) Fax: +61 (0) Document Owner Matthias Merzenich Training Programs Manager Phone: matthias.merzenich@pencs.com.au Melbourne Office Pen CS Level 6, 3 Bowen Crescent Melbourne VIC 3004 Phone: Fax: SUPPORT FREECALL support@pencs.com.au Document Control Version Release Date Modified By Description /06/2015 Matthias Merzenich Initial release 3 July 2015 PAGE 2 of 9

3 1 INTRODUCTION Clinical Audit Tool 4 (CAT4) The Clinical Audit Tool (CAT) analyses clinical information from GP Clinical Desktop Systems. It translates data into real statistical and graphical information that is easy to understand and action. This allows practitioners to assess and improve the quality and completeness of patient information. The benefit to the practice is to assist with its ongoing accreditation and provide opportunities to grow practice income. The emphasis of the tool is to help practice staff to take specific action to improve patient coverage in chronic disease management and prevention. CAT4 is the latest release of our clinical audit tool with many changes to functionality, user interface and performance. CAT4 is part of the CAT Plus suite and has integration links with the other products in the suite. These links are still at an early stage but will gradually be introduced and will make CAT4 a central tool for data quality improvement and patient population management at the practice level. Quick Reference Guides Quick Reference Guides (QRG) are provided as a reference for modules and specific reports in our tools. All user guides are available online at help.pencs.com.au/cat.htm 3 July 2015 PAGE 3 of 9

4 2 Adult Immunisation Overview The Immunisation Indicators project is an initiative of Queensland Aboriginal and Islander Health Council (QAIHC) and the National Centre for Immunisation Research and Surveillance (NCIRS). Its aim is to improve the targeting of vaccinations by reviewing coverage and identifying patients with risk factors. The CAT Adult Immunisations report provides: Graphs which display the immunisation status for the patient population, by disease Influenza Pneumococcal Reports which allow review of immunisation coverage for the patient population by age and risk factors, by disease Influenza Pneumococcal A Risk Factors Filter which allows the practice to target patients with risk factors or conditions requiring immunisation About this Report Notes: 1) Indicators report data for Recent Attenders, Active and Recent Attenders, and All Patients Recent attenders are patients that have had a visit in the last 6 months. Active attenders are patients that have had 3 visits in the last 2 years. All Patients is restricted to patients that have had a visit in the last 2 years. 2) Visit Definition - check the Clinical Audit Tool User Guide Mappings Appendix for your clinical system. 3) In the Adult Immunisations Module an adult >=15 years. References The following documents and resources have been referenced: The Australian Immunisation Handbook 10th Edition 2013 (for conditions associated with an increased risk of invasive pneumococcal) Immunise Australia website > National Immunisation Program National Centre for Immunisation Research and Surveillance website > NCIRS fact sheets 3 July 2015 PAGE 4 of 9

5 3 Influenza Immunisations tab Note 1: The Influenza immunisation is applicable to all age groups Note 2: The CAT filters should be used to target the patient population of interest. Image 1: Influenza Pie Chart The Immunisations > Influenza graph provides a pie chart by last immunisation date. The total population will be displayed by default and the CAT filters should be used to target the adult population or other population of interest. The categories provided are: Current calendar year Previous calendar year Prior to previous calendar year Not recorded 3 July 2015 PAGE 5 of 9

6 4 Adult Immunisations tab Graphs > Pneumococcal Image 2: Adult Immunisation Tab The Immunisations > Adult > Pneumococcal graph provides a pie chart by immunisation status. The population aged >= 15 years will be displayed by default. The categories provided are: Up to date Overdue At Risk, Indigenous, Nothing Recorded At Risk, Non Indigenous, Nothing Recorded At Risk, Unknown 1, Nothing Recorded Non-target group 2 Image 3: Pneumococcal Immunisation Graph 1 Unknown refers to the Indigenous status of a patient has not been recorded in the medical record. Given the different requirements for immunisation (see above), it is important to identify the Indigenous status of patients. 2 The non-target group are patients with no immunisation recorded and who do not require immunisation at this time. The filters should be used to look at target groups. 3 July 2015 PAGE 6 of 9

7 Adult Pneumococcal vaccination rules: Please refer to the Australian Immunisation Handbook for full details and clinical recommendations. Indigenous, if first dose 50 years, 1 revaccination after 5 years if first dose <50 years (at-risk condition), 1 revaccination after 5 years and another at the later of 50 years of age / 5 years All Indigenous NT residents, first dose at 15 years, revaccination after 5 years and again at the later of 50 years of age / 5 years. Non-Indigenous if first dose 65 years, no revaccination. If a risk condition develops, 1 revaccination 5 years after first dose if first dose <65 years (at risk condition), 1 revaccination 5 years later, then another at the later of 65 years of age / 5years 5 Risk Factors Filter The risk factors filter enables practices to search for patients with risk factors that relate to specific immunisations. It allows the practice to search for the categories that are provided in the Immunisation Coverage Reports. The Risk Filter provides: Substance Abuse factors Conditions increasing the risk of pneumococcal 3 - please see appendix Pregnancy Obesity (BMI >=30) Note that the diagnoses categories on the reports are already provided under the Conditions Filters: Diabetes COPD Asthma CVD Image 4: Risk Factor Filter Tab 3 The conditions associated with an increased risk of invasive pneumococcal are provided in The Australian Immunisation Handbook 10th Edition Note that not all conditions listed are able to be extracted from the GP Clinical Systems. 3 July 2015 PAGE 7 of 9

8 6 Reports The Adult Reports are available under the Immunisations > Reports tab. They provide vaccination figures for patients 15 years and over by all patients, recent attendance and recent and active attendance indigenous status gender age risk factor Image 5: Immunisation Report Tab 3 July 2015 PAGE 8 of 9

9 7 Appendix Details of conditions for risk factor filter Category A: Conditions associated with the highest increased risk of IPD functional or anatomical asplenia, including: sickle cell disease or other haemoglobinopathies congenital or acquired asplenia (e.g. splenectomy), splenic dysfunction immunocompromising conditions, including: congenital or acquired immune deficiency, including symptomatic IgG subclass or isolated IgA deficiency (Note: children who require monthly immunoglobulin infusion are unlikely to benefit from vaccination) immunosuppressive therapy (including corticosteroid therapy 2 mg/kg per day of prednisolone or equivalent for more than 1 week) or radiation therapy, where there is sufficient immune reconstitution for vaccine response to be expected currently not extracted haematological and other malignancies solid organ transplant haemopoietic stem cell transplant (HSCT) HIV infection (including AIDS) chronic renal failure, or relapsing or persistent nephrotic syndrome proven or presumptive cerebrospinal fluid (CSF) leak cochlear implants intracranial shunts Category B: Conditions associated with an increased risk of IPD chronic cardiac disease particularly cyanotic heart disease or cardiac failure in children excluding hypertension only (in adults) chronic lung disease, including: chronic lung disease in preterm infants cystic fibrosis severe asthma in adults (requiring frequent hospital visits and use of multiple medications) currently not extracted diabetes mellitus Down syndrome alcoholism chronic liver disease preterm birth at <28 weeks gestation currently not extracted tobacco smoking * See also Vaccination of immunocompromised persons for more recommendations for immunocompromised persons, including more specific revaccination recommendations for haematopoietic stem cell transplant recipients. Recommendations for pneumococcal vaccination differ for those aged >5 years (but not for those aged <5 years) between categories in this table, i.e. depending on whether the person is in Category A: Conditions associated with the highest increased risk of IPD or Category B: Conditions associated with an increased risk of IPD. See also relevant sections below. HSCT recipients require 3 doses of 13vPCV post transplantation, followed by 23vPPV, irrespective of previous vaccine doses received (see Table Recommendations for revaccination following HSCT in children and adults, irrespective of previous immunisation history). All infants born at <28 weeks gestation should receive vaccines recommended for those up to age 5 years with a medical condition(s) associated with an increased risk of IPD, according to Table Thereafter, they only require further pneumococcal vaccine doses if they have chronic lung disease, and/or other chronic medical conditions as specified above. Tobacco smoking is not a medical condition, but is associated with an increased risk of IPD. 3 July 2015 PAGE 9 of 9