Project based approach to increasing uptake of influenza vaccine in an underachieving GP practice

Abstract

Influenza is a major cause of morbidity and mortality (DH, 2006; Watson et al 2001). In the United Kingdom (UK), the policy of encouraging influenza vaccine uptake in elderly people is a central tenet of managing winter pressures in the National Health Service (NHS) and preventing ill health among older people in the community. A project based management approach was used to evaluate the organisational practice within a single-handed general practitioner (GP) practice during the 2005/06 Influenza Immunisation Programme. The project highlighted a number of problems such as a poorly structured programme, insufficient knowledge about the severity of influenza or the efficacy of the vaccine, and insufficient computer technology. A stepwise process and a number of evidence based interventions were implemented with the aim of increasing the uptake of influenza vaccine in the target population. The overall aim of the project was to show a measured practice increase in the number of older people, defined as 65 years and over, taking up influenza vaccine within one influenza campaign. An increase of 35.71% was achieved. The findings of this project have the potential to inform and enhance the design and implementation of the influenza programmes in other practices that are experiencing difficulties in achieving a good influenza immunisation uptake.

Keywords

Influenza vaccination uptake health promotion health professional older people project infection

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References

Ahmed AE , Nicholson KG , Nguyen-Van-Tam JS (1995) Reduction in mortality associated with influenza vaccine during the 1989—1990 epidemic. Lancet 346: 591—5.

Burns VE , Ring C. , Carroll D. (2005) Factors influencing influenza vaccination uptake in an elderly, community-based sample. Vaccine 23: 3604—8.

Chief Medical Officer. Influenza immunizations. 1 August 2000, PL/ CMO/2000/3.

Department of Health (2007) The Influenza Immunisation Programme PL/CMO/2007/3, PL/CNO/2007/1, PL/CPHO/2007/1 , London. Department of Health. (2006) Immunisation against infectious diseases. London: DH, 2006: pp. 185—200.

Dixon-Woods M. , Brown H. , Arthur A. , Matthews R. , Jagger C. (2004) Organising services for influenza vaccination for older people. Journal of Health Services Research and Policy 9(2): 85—90.

Donaldson L. (2000) CMO's update 1—2, 2000, 26. PL/CM/2000/3 . Duclos P. , Hatcher J. (1993) Epidemiology of influenza vaccination in Canada . Canadian Journal of Public Health 84: 311—15.

Fleming DM (2000) The contribution of influenza to combined acute respiratory infections, hospital admissions, and death in winter. Communicable Disease and Public Health 3: 32—8.

Forbes A. , Berry J. , While A. , Hitman G. , Sinclair A. (2002) Issues and methodological challenges in developing and evaluating health care interventions for older people with diabetes mellitus, part 1. Practical Diabetes International 19(2): 55—9.

Furey A. , Robinson E. , Young Y. (2001) Improving influenza immunisation coverage in 2000—2001: a baseline survey, review of the evidence and sharing best practice. Communicable Disease and Public Health 3: 183—7.

10.

Health Protection Agency North West. (2003 ) Seasonal diseases winter infections — winter 2003—04 . See: http://www.hpa.org.uk/infections/topics_az/influenza/seasonal/influenza_0304.htm

11.

Healthcare Commission. Performance ratings . (2004) www.healthcarecommission.org.uk (accessed 10 June 2006).

12.

Honkanen PO , Keistinen T. , Kivela SI (1996) Factors associated with influenza vaccination coverage among the elderly: role of healthcare personnel. Public Health 110: 163—8.

13.

Joint Committee on Vaccination and Immunisation. (2007) Influenza subgroup meeting on 14 February 2007. Minutes. See: http://www.advisorybodies.doh.gov.uk/jcvi/mins-flu140207.htm (accessed 16 July 2007).

14.

Joseph C. (2004) Implementing the national influenza vaccine uptake monitoring programme, England. British Journal of Infection Control 5: 31—2.

15.

Monto AS , Hornbuckle K. , Ohmit SE (2001) Influenza vaccine effectiveness among elderly nursing home residents: a cohort study. American Journal of Epidemiology 154: 155—60.

16.

National Health Service. (2000) International Statistical Classification of Disease and Related Health Problems. 10th Revision (ICD-10). See: www.connectingforhealth.nhs.uk/clinicalcoding/classifications/icd_10 (accessed 25 April 2006).

17.

Nguyen-Van-Tam JS (1998) Epidemiology of influenza. In: Nicholson KG , Webster RG , Hay AJ (eds). Textbook of influenza. Blackwell: Oxford.

18.

Nicholson KG , Kent J. , Hammersley V. (1999) Influenza A among community-dwelling elderly persons in Leicestershire during winter 1993—4; cigarette smoking as a risk factor and the efficacy of influenzas vaccination. Epidemiology and Infection 123: 103—8.

19.

Plotkin SA , Orenstein WA (eds). (2004) Vaccines, 4th edn. WB Saunders Co: Philadelphia : chapter 8.

20.

Robinson E. (1999) Be aware of the implications of influenza. Practice Nurse 18(6): 378—84.

21.

Voordouw Acg , Sturkenboom Mcjm , Dieleman JP , Stijnen Th. , Smith DJ , van der Lei J. , Stricker BH (2004) Annual revaccination against influenza and mortality risk on community-dwelling elderly persons. Journal of the American Medical Association 292(17): 2989—95.

22.

Watson JM , Goddard N. , Joseph C. , Zambon MC (2001) Influenza: the impact of the 1999/2000 epidemic on morbidity and mortality in the UK. In: Osterhaus ADME (ed.) Options for the control of influenza Elsevier, pp. 31—3. (International Congress Series 1219: 21—3, 2001 .)

23.

Wiselka M. (1994) Influenza: diagnosis, management and prophylaxis . British Medical Journal 308: 1341—5.