Collection of influenza immunisation uptake data from General Practices Simon Cottrell, Public Health Wales Communicable Disease Surveillance Centre and Vaccine Preventable Disease Programme simon.cottrell@wales.nhs.uk

Acknowledgements Thanks to: General Practices Health Board Immunisation Coordinators NWIS Primary Care Informatics Team (PCIT) Public Health Wales Vaccine Preventable Disease Programme Public Health Wales Communicable Disease Surveillance Centre Surveillance using Audit+

Flu immunisation in Wales High burden of disease caused by influenza Free vaccination available for: 65y and older, clinical risk groups, pregnant women, 2 to 7 year olds, health and social care staff, carers and those in long stay care Targets: 75% uptake in 65y+ and clinical risk groups 50% in NHS staff Excess seasonal mortality in UK in 2014/15 – 16,000+ In European region up to 50 million flu cases annually, estimated between 15,000 and 70,000 deaths annually Places a substantial burden on health care services 75% target, suggested by WHO based on reducing transmission. Very challenging with few countries in Europe achieving it. 50% uptake in staff a more achievable operational target (will increase in future) Surveillance using Audit+

Flu immunisation in Wales This is where we are the moment. One of the highest uptakes in Europe (although lowest in the UK in many areas), but only achieving target for pregnant women. Front-line NHS staff: 47.3% Surveillance using Audit+

Collection of flu immunisation uptake data 2003: Taken on by NPHS, paper-based questionnaire, chase-up by immunisation coordinators (80% response rate) 2004/5: Semi-automated collection through MSD Clinical Audit (91% response rate), one-off collection in March/ April 2007/8: First automated collection through Audit+ (85% response rate), one-off collection in April 2015/16: Automated weekly data collection using Audit+, end of season response rate 100% Surveillance using Audit+

Who uses Audit+ surveillance reports produced by Public Health Wales? Practices Health Boards Public Health Wales Local Public Health Teams Welsh Government PHE for UK reports ECDC (European Communicable Disease Control) WHO A variety of people use the surveillance reports which Public Health Wales produces using data collected from General Practices. Surveillance using Audit+

How Audit+ data is collected Data quality Audit+ Consultation GP database Read code GP surv module Adult Imms module Other modules Public Health Wales Health Protection Routine disease surveillance Vaccination surveillance Monitoring PH emergencies Monitoring mass gatherings Aggregate data Other users e.g. SAIL Dis/aggregate data NWIS PCIT Manage Audit+. Author searches. Informatica Technical. Deploy modules/ searches This is a simplified diagram to show how the surveillance data which is used by Public Health Wales is collected. Diagnoses and treatments in General Practices are entered on to the practice database, using appropriate Read codes. The Audit+ software is able to search the practice database for Read codes which have been specified beforehand by Public Health Wales and NWIS PCIT; and send the relevant, anonymous data to Public Health Wales CDSC to be analysed and reported back as disease rates, vaccine uptake rates, etc. Others also use data collected using Audit+ (e.g. SAIL for academic research purposes). Surveillance using Audit+

Data collected by PHW CDSC and VPDP Consultation data (eg’s) Flu-like illness gastroenteritis heatstroke chicken pox Vaccination uptake data Influenza Shingles Pneumococcal MenACWY Surveillance using Audit+

Flu immunisations, which data? Policy Read code specifications JCVI Audit + data collection requirements Surveillance Surveillance using Audit+

Reporting influenza immunisation uptake data End of season report Influenza Vaccination Online Reporting (IVOR) Operationally useful real-time reports for: GPs, HBs, PHW and WG Weekly reports at: Health board level LA level Cluster level Practice level Surveillance using Audit+

IVOR Surveillance using Audit+

IVOR Surveillance using Audit+

Weekly analysis Surveillance using Audit+ We collect data and monitor the uptake of flu immunisation uptake throughout the flu season. In this way we can see how many people have been vaccinated before the virus starts to circulate in the community. Surveillance using Audit+

Weekly analysis Surveillance using Audit+ This chart shows weekly flu immunisation uptake in patients aged 65y and older in more detail. It is a box and whisker plot, which shows the spread of uptake in General Practices reported each week through Audit+. The centre line in each of the blue boxes is the median (average) of practice level uptakes that were reported through Audit+ that week. The box shows the spread of the central 50% of practice level uptakes and the whiskers show you the approximately the central 95% spread of uptake in general practices. The dots are outlier practices, where uptake is either unusually low or unusually high. Monitoring practice level uptake throughout the season is important, because it lets us identify where there may be issues with practices not being able to submit using Audit+ or where there is something affecting the quality of data coming in from some practices. The outliers circled in red are practices where there were issues affecting data quality, using the practice level data throughout the season allowed us identify issues and allowed the Primary Care Informatics Team to target help and advice to practices to rectify any issues. Surveillance using Audit+

Data quality and interpreting reports Weekly reports, weekly queries on data quality Most reported data quality issues weren’t Investment needed in training for data users on interpretation Increased use and understanding of reports leads to better data quality Useful feedback from data users and advice on encouraging use of reports Requests for weekly reporting of uptake arose from GP, HB, PHW and WG. In addition to meeting demand, weekly reporting allows us to investigate and maintain data quality. Gather feedback and advice on usefulness and appropriateness of reports. Help service users understand and interpret the reports. Surveillance using Audit+

100 patients aged 65y and older at the start of the campaign 10 patients are contraindicated 13 patients decline when invited 59 patients are immunised So what is the uptake? 59/90 x 100 = 65.5% 59/77 x 100 = 76.6% 59/100 X 100 = 59% Set in place training for general practices and health boards on use and interpretation the data. Things that we take for granted as simple often turn out to be more complicated for others in the process.

Useful links Further information on Public Health Wales surveillance of flu immunisation uptake using Audit+: http://howis.wales.nhs.uk/sites3/page.cfm?orgid=474&pid=53940 Public Health Wales bulletins and reports CDSC weekly flu surveillance report: www.publichealthwales.org/flu-activity CDSC weekly GP newsletter: http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=25305 VPDP monthly immunisation e-bulletin http://howis.wales.nhs.uk/sites3/page.cfm?orgid=474&pid=21315 Sign-up to receive notifications of updates on immunisations: http://nww2.nphs.wales.nhs.uk:8080/vpdpEBulletins.nsf/RegistrationForm Surveillance using Audit+

Thank you Questions? Surveillance using Audit+