Provision Of Influenza Vaccine Research Articles

THU0154 PERCEPTIONS ABOUT INTERVENTIONS TO ENHANCE INFLUENZA VACCINE UPTAKE DIFFER BETWEEN VACCINATED AND UNVACCINATED RA/JIA PATIENTS

Background:To optimize the control of vaccine preventable diseases, high immunization coverage rates must be achieved. Influenza vaccination rates among patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are suboptimal. Understanding patient preferences for interventions that may increase vaccine uptake is the first step to inform the development of specific strategies to enhance vaccine coverage in RA/JIA.Objectives:To compare the perceptions of vaccinated and unvaccinated RA/JIA patients on a multi-modal intervention to enhance seasonal influenza vaccine coverage.Methods:During the 2018-2019 influenza season, a multi-modal intervention was implemented at a large Canadian academic center. This consisted of (i) a letter sent from the Division of Rheumatology to patients addressing common misconceptions about flu vaccines and encouraging patients to plan for immunization; (ii) a nurse providing inactivated influenza vaccine at the rheumatology clinics for the first 7 weeks after the vaccine was released, and (iii) clinics posters specifically designed for rheumatic patients and rheumatologists to prompt a discussion on influenza prevention. Patients that were vaccinated on site completed a survey evaluating the relevance of the individual components of the intervention. After the intervention, during a scheduled rheumatology visit, RA/JIA patients were asked to complete a similar survey. We compared the responses from RA/JIA patients that were vaccinated at our institution, to those of patients that reported not having received the influenza vaccine in 2018-2019.Results:During the intervention, 116 immunized RA/JIA patients completed the first survey. Forty RA/JIA patients not vaccinated during the 2018-2019 season completed the post-intervention survey. Both vaccinated and unvaccinated groups were mostly female (74.1% versus 87.2%), but vaccinated patients were older (50.8±19.4 versus: 40.5±14.9; 95% CI 3.7%,17%), and had shorter disease duration (10.1±9.3 versus 15.0±9.8; 95% CI -8.9%,-1.1%) than those not vaccinated. Unvaccinated patients were less likely than vaccinated patients to approve of the clinic’s provision of influenza vaccine (98.2% versus 75%; 95% CI 12.8%, 43.5%). When asked about elements of the intervention, unvaccinated patients were less likely than vaccinated patients to consider posters (65.2% versus 38.9%; 95% CI 7.9%, 42.9%), letters (69.4% versus 35.3%; 95% CI 16.2%, 51.2%), or phone calls (58.0% versus 41.7%; 95% CI 2.1%, 33.5%) as good reminders.Conclusion:Unvaccinated RA/JIA patients’ opinions about interventions to increase vaccine uptake differ from vaccinated patients. Alternative, novel strategies to target vaccine hesitant RA/JIA patients are needed to optimize vaccine coverage.Disclosure of Interests:None declared

A cross-sectional survey of enhanced and extended professional services in community pharmacies: A pharmacy perspective.

Community pharmacies provide enhanced (within current scope of practice) and extended (requiring additional credentialing) services, for disease state management and primary care. To quantify the prevalence and characteristics of extended and enhanced professional services offered by community pharmacies in Western Australia (WA), their frequency of remuneration, facilitators, barriers and factors influencing their provision. A questionnaire was mailed to a random sample of 421/628 (67.0%) community pharmacies in WA. Data collected included demographic information, provision of extended and enhanced pharmacy services and whether remuneration was received. Facilitators and barriers for offering these services used Likert scale responses to proffered questions. Data were entered into SPSS and descriptive statistics were reported. Logistic regression analyses investigated any factors (pharmacist and pharmacy characteristics) associated with the provision of influenza vaccination, or any of nine selected enhanced services. The response rate was 205/417 (49.2%). Only one-half or less of respondents provided any extended services. Pharmacist-administered influenza vaccinations (94/205, 45.0%) and Home Medicines Reviews (105/205, 52.0%) were the most prevalent. Remuneration for extended services was received by > 60% of respondents. Of 18 enhanced services >80% of pharmacies provided blood pressure monitoring and needle and syringe programs. Over half of the pharmacies (113/205, 55.1%) were banner (franchise) group members. Belonging to a banner group, having a private consultation area and space for a patient to lie down were positively associated with the provision of influenza vaccination and the selected enhanced services. Facilitators for the provision of services included enhancing patient relationships and the role of pharmacists. Major barriers were time constraints and inadequate remuneration. Extended services were limited in scope and provision whilst enhanced services were not uniformly available. Pharmacy organisations should look to increase their scope and provision, including improved government and third-party funding.

Knowledge, attitudes, beliefs, and barriers associated with the uptake of influenza vaccine among pregnant women

Objective: The purpose of the study was to assess the knowledge, attitudes, beliefs, and factors associated with the uptake of the influenza (flu) vaccination in women within Saudi Arabia during their pregnancy period. Methods: A cross-sectional prospective survey was conducted on 1085 pregnant women at the antenatal clinic over a period of 6 weeks with the provision of influenza vaccination. The questionnaire collected demographic and other data; it included 12 questions on their general knowledge and assessed their attitude toward influenza vaccination, and their awareness of vaccine risk and the potential benefits during pregnancy. The knowledge score obtained was then calculated and compared. Results: A total of 998 patients took part in the questionnaire with a response rate of 92%. There was poor awareness that the flu vaccine is safe to administer during pregnancy (130, 13.1%) and that all pregnant women should receive the flu vaccine (190, 19.1%). Pregnant women with flu vaccine knowledge score of ⩽5 (range 0–12) were significantly less likely to take the vaccine (OR 3.78, 95% CI 2.68–5.26, p<0.001). There was a low uptake of the vaccine (178, 18.1%) and only 29 (3.0%) had previously been offered the flu vaccine by any doctor during their pregnancy. In addition, 255 (25.8%) were against taking the flu vaccine during pregnancy. Conclusion: The knowledge and uptake of the influenza vaccine among Saudi pregnant women are low. One quarter was against the vaccine during pregnancy. Very few believed the flu vaccine to be safe during pregnancy. Rarely, physicians advise their clients to take flu vaccine.

Strategies to Improve Influenza Vaccination in Pediatric Inflammatory Bowel Disease Through Education and Access.

Influenza vaccine uptake remains low in patients with inflammatory bowel disease despite an increased risk of complications from infection. We studied barriers to vaccination and evaluated the impact of an educational intervention and vaccine provision in pediatric patients with inflammatory bowel disease. A prospective cohort study was completed over 2 successive influenza seasons. In year 1, we surveyed parents and patients aged 14 years or older regarding influenza vaccination. In year 2, before the influenza season, patients were provided with an educational module. After influenza vaccine availability, patients were offered both education and vaccine in clinic. Chi-squared analysis was used to identify significant differences in vaccination rates in each intervention group. Demographic factors were associated with vaccination status. In year 1, 180 parents and 183 adolescents completed the survey. In year 1, 47% of patients obtained the influenza vaccine and 34% of patients reported obtaining the vaccine annually. Top reasons for nonvaccination were perceived lack of benefit (28%) and concerns about adverse events (19%). In year 2 (n = 228), the vaccination rate in patients who received the education alone was 75.0%, compared with 89.5% of patients who received both education and vaccine access in clinic (P = 0.0043). Among the patients who took part in both study years (n = 129), influenza vaccination rates increased from 45% in year 1 to 82% in year 2 (P < 0.0001). The educational intervention was associated with improved influenza vaccination rates. Additional vaccine uptake was achieved with provision of influenza vaccination during clinic visits.

Cost of universal influenza vaccination of children in pediatric practices.

The goals were to estimate nationally representative pediatric practices' costs of providing influenza vaccination during the 2006-2007 season and to simulate the costs pediatric practices might incur when implementing universal influenza vaccination for US children aged 6 months to 18 years. We surveyed a stratified, random sample of New York State pediatric practices (N = 91) to obtain information from physicians and office managers about all practice resources associated with provision of influenza vaccination. We estimated vaccination costs for 2 practice sizes (small and large) and 3 geographic areas (urban, suburban, and rural). We adjusted these data to obtain national estimates of the total practice cost (in 2006 dollars) for providing 1 influenza vaccination to children aged 6 months to 18 years. Among all respondents, the median total cost per vaccination was $28.62 (interquartile range: $18.67-45.28). The median component costs were as follows: clinical personnel labor costs, $2.01; nonclinical personnel labor costs, $7.96; all other (overhead) costs, $10.43. Vaccine purchase costs averaged $8.22. Smaller practices and urban practices had higher costs than larger or suburban practices. With the assumption of vaccine administration reimbursement for all Vaccines for Children (VFC)-eligible children at the current Medicaid median of $8.40, the financial loss across all US pediatric practices through delivery of VFC vaccines would be $98 million if one third of children received influenza vaccine. The total cost for pediatric practices to provide influenza vaccination is high, varies according to practice characteristics, and exceeds the average VFC reimbursement.

Delivery of Influenza Vaccine to Nonelderly Persons with Cardiovascular Disease, with Varying National Supply of Vaccine: A Decision Analysis

Influenza immunization rates among nonelderly persons at high risk for influenza are far below target levels in the United States. Provision of influenza vaccine at subspecialty practices can target high-risk patients, particularly during influenza vaccine shortages. We conducted a decision analysis to explore the potential effects on nonelderly cardiac patients’ immunization rates of improving vaccine availability, standing orders rates, and physicians’ vaccine recommendation rates in cardiology, primary care, and other medical subspecialty outpatient practices. We considered 2 supply circumstances (sufficient versus 50% of needed supply), and also incorporated community and hospital-based vaccine delivery as well as patient acceptance in the model. With sufficient vaccine supply, optimized performance of cardiology practices (maximum vaccine availability, strong physician recommendations, and standing orders) yielded greater improvement in vaccine coverage rate than with separately optimized performance in primary care, pulmonology, or endocrinology practices. With only 50% of needed vaccine supply, reallocation of doses from community sites to primary care and cardiology, pulmonology, and endocrine offices yielded higher estimated immunization rates in the target population than strategies without reallocation. Only with simultaneous interventions across primary care, subspecialty care, inpatient, and community domains did immunization rates exceed 60%. Targeted interventions to optimize delivery of influenza vaccine in cardiology practices may be the most effective means of raising vaccine coverage levels among nonelderly cardiovascular patients, in times of varying national vaccine supply.