Improving influenza and pneumococcal vaccination rates in primary care

Prof A Niroshan Siriwardena
University of Lincoln
Quality Improvement in research and education

Summary

Influenza (flu) is a common, potentially severe, but preventable infection that places a high burden on patients and healthcare providers. A safe, effective vaccine is offered annually by general practices to at-risk groups in the UK. People in at-risk groups, comprising 27% of the population, have a higher chance of contracting severe flu infection or its complications. There are 36/100,000 population deaths per year in the UK (an additional 12,000 per year) due directly to influenza, and of these, approximately two-thirds are in a vaccination risk group. However, only a quarter of those at risk receive vaccination and uptake of seasonal influenza vaccination in the UK’s at-risk population is below the national and international target of 75%.1. The research is both evaluative, i.e. shows which immunisation strategies work best, and exploratory, e.g. identifies important associations between influenza immunisation and prevention of illness or death.

What are the Aims?

The research aimed to improve uptake of seasonal flu and pneumococcal vaccination in the UK’s at-risk population, to investigate the link between respiratory infection and AMI or stroke/transient ischaemic attack (TIA or ‘mini-stroke’), and to explore the potential for flu or pneumococcal vaccination to prevent AMI or stroke/TIA.

Who was/is involved?

The research was carried out by members of the Community and Health Research Unit (CaHRU).

What has changed/will change?

This research has had broad international and national impact on community-based prevention, influencing influenza and pneumococcal vaccination policy and practice in the UK, North America and Australia, and impacting on general practitioner and primary healthcare. We identified key strategies such as communication between professionals, provider prompts, and practice organisation, that were significantly associated with success of general practice seasonal flu vaccination and pneumococcal vaccination campaigns and we helped practices to implement these through educational programmes. We also showed that practices, where primary care teams received an educational outreach visit in addition to audit and feedback, demonstrated a significantly greater uptake in high-risk groups for pneumococcal but not influenza vaccine, compared with practices who received audit and feedback alone. We conducted a large case-control study which showed that influenza vaccination but not pneumococcal vaccination was associated with a reduced rate of first acute myocardial infarction and this finding was confirmed in a self-controlled case series study.

What lessons have we learnt?

The research has increased public and practitioner awareness of the link between influenza and cardiovascular disease and the potential for influenza vaccination to prevent acute myocardial infarction (AMI) and stroke.

This study has had broad international and national impact on community-based prevention, influencing influenza and pneumococcal vaccination policy and practice in the UK, North America and Australia, and impacting on general practitioner and primary healthcare.

Findings have been incorporated into national guidance for general practices and e-learning on how to improve UK influenza vaccination rates. 

This has led to improvements in influenza vaccination in the elderly aged 65 years and over as well as younger people aged two years and over at risk of influenza and pneumonia, in Lincolnshire, UK and internationally via policy, education and guidance since 1999.

Contact details

Professor Niro Siriwardena nsiriwardena@lincoln.ac.uk

Links to further information and resources

More information about this case study:
www.lincoln.ac.uk/home/research/researchshowcase/reducingheartattackriskwithvaccinations