Strategies for Late Season Flu Vaccination 40th National Immunization Conference of CDC March 7, 2006 Victoria Davey, RN, MPH Office of Public Health and Environmental Hazards Department of Veterans Affairs Washington, DC

VA Health Care 5.1 million patients/year 7.5 million enrolled for care 1,300 Sites-of-Care 158 medical centers or hospitals, 850 clinics, long-term care, domiciliaries, home-care programs $27.4 billion budget 193,000 Employees (~15,000 MD, 56,000 Nurses, 33,000 Allied Health Professionals)

VA Health Care Affiliations with 107 Academic Health Systems Additional 25,000 affiliated MD’s Largest provider of health professional education Most US health professionals (70% MD’s) have some training in VA $1.7 Billion Research Program Basic, Clinical (Cooperative Studies), Rehabilitation, Health Services Research

VA Health Care A truly “national” healthcare system Increasingly recognized as leader in quality of care: Heart disease Diabetes Prosthetics HIV Hepatitis C Fully deployed Electronic Health Record—uniform throughout U.S.

Annual Flu Vaccination How does VA do?

VA Patient Flu Immunization Rates Chart Review 02-03 03-04 04-05 VA Performance Goals 03-05 HP 2010 Goal Veterans (> 49 yo, or w/ chronic illness) 70% 75% 79-82% 90% Source: External Peer Review Program Surveys, 2003 -2005, 11 clinics + SCI & D

VA Patients’ Self-Reported Flu Vaccination Rates FY 03 All (> 49 yo) 75% >64 yo 84% NH Whites 74% NH Blacks 60% Non-VA vaccine 45% n=102,347 FY 04 All (> 49 yo) 82% >64 yo 88% NH Whites 83% NH Blacks 72% Non-VA vaccine 38% n=159,142 Source: Survey of Healthcare Experiences of Veterans (SHEP)

VA Staff Flu Vaccination Rates Anecdotes: rates of 80-90% of facility staff (this season) Probably a very wide range System-wide survey this year

Seasonal Flu: VA’s Annual Actions Annual Under Secretary for Health Directive Communicates priorities, implementation issues Setting goals/performance measures for flu vaccination—advised by VA “Flu” Group Purchase / distribution of flu vaccine supplies Dissemination of VA Influenza Toolkit VA Influenza Vaccine Advisories Regular reminders, guidance Leadership speaks Infection: Don’t Pass It On Campaign

VA’s Priority Groups 05-06 Flu Season Pts >65yrs old Pts of any age with comorbid conditions Residents of VA’s long term care facilities (including group or shelter situations) Pregnant women veterans Personnel who work in VA healthcare facilities Veteran household contacts and out-of-home caregivers of children aged <6months

VA’s Goals for 2005-2006 Season Increase rates of vaccination in personnel at all sites Maintain/Increase rates of vaccination of veteran patients Provide pneumococcal vaccination where indicated Involve all staff and providers in promoting influenza vaccination Promote nonvaccine methods of preventing infection (hand/respiratory hygiene)

Seasonal Flu: VA’s Annual Actions Annual Under Secretary for Health Directive Communicates priorities, implementation issues Setting goals/performance measures for flu vaccination Purchase / distribution of flu vaccine supplies Dissemination of VA Influenza Toolkit Regular reminders, guidance VA Influenza Vaccine Advisories Leadership speaks Infection: Don’t Pass It On Campaign

VA’s Flu Vaccine Purchases Year Doses Purchased 1998 986,530 1999 1,163,250 2000 1,461,280 2001 1,841,760 2002 1,587,250 2003 2,049,750 2004 2,070,790 2005 2,240,000

Seasonal Flu: VA’s Annual Actions Annual Under Secretary for Health Directive Communicates priorities, implementation issues Setting goals/performance measures for flu vaccination Purchase / distribution of flu vaccine supplies Dissemination of VA Influenza Toolkit VA Influenza Vaccine Advisories Regular reminders, guidance Leadership speaks Infection: Don’t Pass It On Campaign

Methods to improve staff and patient vaccination rates Vaccine Information Inactivated influenza, LAIV, pneumococcal Methods to improve staff and patient vaccination rates 88% of veterans >64; assessing staff rates this year Tools for Flu Prevention Buttons, stickers, posters Frequently asked questions Eligibility for vaccine, HIV/AIDS, vaccine storage, LAIV Resources, references, and web sites

Toolkit materials sent to 8 key contact groups at each VA medical center Influenza vaccination (“flu”) coordinators Occupational health clinicians Prevention coordinators Infection control professionals Public affairs officers Patient educators Patient safety officers Education contacts

Seasonal Flu: VA’s Annual Actions Annual Under Secretary for Health Directive Communicates priorities, implementation issues Setting goals/performance measures for flu vaccination Purchase / distribution of flu vaccine supplies Dissemination of VA Influenza Toolkit VA Influenza Vaccine Advisories Regular reminders, guidance Leadership speaks Infection: Don’t Pass It On Campaign

USH Flu Vaccine Advisories 2005 - 2006 VA Influenza Vaccine Advisory #4 for the 2005-2006 Influenza Season   VA_Flu_Vaccine_Advisory_4_2-2006.pdf  (220k PDF file)   VA_Flu_Vaccine_Advisory_4_11-2005.tif  (233k TIFF image file) VA Influenza Vaccine Advisory Attachment Revised/renamed fact sheet: Prevention and Treatment of Seasonal Influenza A and B Using Oseltamivir, updated January 2006    PxandRxofSeasonalFluwoseltamivir.Jan2006.pdf   (43k PDF file) Seasonal Influenza VA will follow CDC recommendation against the use of amantadine and rimantadine this season Continue the VA Influenza Vaccination Program this season Use public health measures to prevent and control seasonal influenza Under Secretary for Health Issues new guidance, advice, feeds back data, and thanks the “field” 7 in 04-05 season 4 in 05-06 to date

More system-wide strategies… Ongoing reminders Weekly emailed “VA Flu Campaign TIP OF THE WEEK” Ideas solicited from VA clinicians Mid-October to February Sent in a nicely-designed email to 1000s of staff National focus groups Held twice in January What works for your site’s flu campaign? How can VA Central Office help? Infuenza A – early passage

More system-wide strategies… Ongoing production and dissemination of “tools” A lower reading level VIS For use with the CDC version Posters tailored to VA audiences Including CDC materials (thanks) Web-based survey to evaluate Flu Toolkit Ideas for next year Infuenza A – early passage

Seasonal Flu: VA’s Annual Actions Annual Under Secretary for Health Directive Communicates priorities, implementation issues Setting goals/performance measures for flu vaccination Purchase / distribution of flu vaccine supplies Dissemination of VA Influenza Toolkit Regular reminders, guidance VA Influenza Vaccine Advisories Leadership speaks Infection: Don’t Pass It On Campaign

Infection: Don’t Pass It On Non-vaccine preventive measures encouraged in an active national campaign hand hygiene, respiratory hygiene http://www.publichealth.va.gov/infectiondontpassiton

Late season vaccination—how does VA do?

2004-2005 Flu Vaccine Utilization As of April 6, 2005 1,874,176 doses used (91%) 16% was administered mid January-March Metrics for 05-06 being collected For VA patients For VA health care facility staff

Summary--strategies to achieve late season vaccination Set system-wide goals—specific to the season Make flu vaccination of patients a performance measure for health care facilities Keep leadership visible and vocal throughout the season Communication, communication, communication Establish multidisciplinary “key” contacts Listen to the advice of staff and patients and share/act on it Act quickly when policy changes are needed Invest resources Toolkits, promotional items, awards to field staff who contribute or innovate

VA Web Resources www.publichealth.va.gov/flu/ www.publichealth.va.gov/infectiondontpassiton