Improving access to seasonal influenza vaccine

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Presentation transcript:

Improving access to seasonal influenza vaccine Survey of clinic activity relating to flu vaccination for adults with HIV

Background Annual seasonal influenza (flu) vaccination is recommended for adults with HIV infection 2008 BHIVA guidelines proposed a target of 95% for offer of annual flu vaccine to individuals with HIV In the 2015 BHIVA audit of routine monitoring, 21.1% of audited patients had received flu vaccine and a further 36.2% had been advised to obtain this from a GP

Background, continued Relevant issues include that flu vaccination is: Seasonal (in autumn) rather than annual as and when a patient is seen Usually administered in primary care and not always available in specialist HIV clinics

Method and participation 135 HIV specialist clinical services completed an online survey about their practice in enabling adults with HIV to access flu vaccine

Availability of flu vaccine

Action to inform GPs about HIV patients’ eligibility for flu vaccine All clinics Clinics which do not stock vaccine Write to GP seasonally, unless consent refused 46 (34%) 19 (39%) Mention flu vaccine in standard GP letter 70 (52%) 26 (54%) Inform GP re flu vaccine eligibility for newly diagnosed patients, unless consent refused 45 (33%) 21 (44%) Any reported HIV clinic action to inform GP 114 (84) 44 (92%)

Action to inform patients All clinics Contact patients seasonally, unless consent refused 22 (16%) Advise if attending for routine bloods during season 97 (72%) Advise if attending for clinician review during season 117 (87%) Include in protocol for annual clinician review, regardless of time of year 77 (57%) Include in protocol for new patient assessment 80 (59%) Offer note/certificate of eligibility 5 (4%) Display posters/leaflets 32 (24%)

Recording 73 (54%) of clinics have a system and aim to routinely record when HIV patients are given advice about flu vaccine 64 (47%) of clinics have a system and aim to routinely record uptake of flu vaccine

New activity in 2015/6 season 28 (21%) services changed procedures or practice in autumn 2015/winter 2016 In one case commissioners withdrew funding for vaccine in clinic, leaving 27 (20%) who did so by choice 15 (11%) were influenced by the 2015 BHIVA monitoring audit and 5 (4%) by the CMOs’ letter

Improvements included: Adding prompts or similar to EPRs/ proformas Altering standard GP letters Improving advice to patients Conducting audit 2 services had audited the effect of change and 15 planned to do so

Conclusions It is encouraging that: most services take action to advise both patients and GPs about flu vaccine eligibility 20% report quality improvement in the past year

Recommendation For further improvement and ensuring coverage whether or not an HIV patient attends during the vaccine season, all services should: Mention flu vaccine eligibility routinely in GP letters (eg footnote in standard template) Include asking about flu vaccine in EPRs/proformas for annual clinician review Consider feasibility of reminding patients (eg by text) at start of flu vaccine season Consider auditing recording of flu vaccine advice to patients

Acknowledgements Thanks to all clinical services which completed the survey. BHIVA Audit and Standards Sub-Committee: B Angus, D Asboe, F Burns, R Byrne, D Chadwick, D Churchill, H Curtis (co-ordinator), V Delpech, K Doerholt, A Freedman (chair), A Molloy, J Musonda, N Naous, O Olarinde, E Ong, S Raffe, C Sabin, A Sullivan.