A review of hospital-based interventions to improve inpatient influenza vaccination uptake for high-risk adults

McFadden, Kathleen; Seale, Holly

doi:10.1016/j.vaccine.2020.12.042

Cited by 18 publications

(21 citation statements)

References 48 publications

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“…This could be achieved by extensive patient and community-wide education for example by sending informational letters, as previously demonstrated in a Californian randomized trial [ 58 ], or provision of vaccination services at pharmacies. In addition, hospitalization for acute illness could be another opportunity to educate patients, and in the absence of acute contraindications, to vaccinate them, as vaccination is safe and effective in hospitalized patients and increases vaccination rates substantially as shown previously [ 59 – 61 ].…”

Section: Discussionmentioning

confidence: 97%

Cross-sectional study on the prevalence of influenza and pneumococcal vaccination and its association with health conditions and risk factors among hospitalized multimorbid older patients

et al. 2021

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Background Older adults with chronic conditions are at high risk of complications from influenza and pneumococcal infections. Evidence about factors associated with influenza and pneumococcal vaccination among older multimorbid persons in Europe is limited. The aim of this study was to investigate the prevalence and determinants of these vaccinations in this population. Methods Multimorbid patients aged ≥70 years with polypharmacy were enrolled in 4 European centers in Switzerland, Belgium, the Netherlands, and Ireland. Data on vaccinations, demographics, health care contacts, and comorbidities were obtained from self-report, general practitioners and medical records. The association of comorbidities or medical contacts with vaccination status was assessed using multivariable adjusted log-binomial regression models. Results Among 1956 participants with available influenza vaccination data (median age 79 years, 45% women), 1314 (67%) received an influenza vaccination within the last year. Of 1400 patients with available pneumococcal vaccination data (median age 79 years, 46% women), prevalence of pneumococcal vaccination was 21% (n = 291). The prevalence of vaccination remained low in high-risk populations with chronic respiratory disease (34%) or diabetes (24%), but increased with an increasing number of outpatient medical contacts. Chronic respiratory disease was independently associated with the receipt of both influenza and pneumococcal vaccinations (prevalence ratio [PR] 1.09, 95% confidence interval [CI] 1.03–1.16; and PR 2.03, 95%CI 1.22–3.40, respectively), as was diabetes (PR 1.06, 95%CI 1.03–1.08; PR 1.24, 95%CI 1.16–1.34, respectively). An independent association was found between number of general practitioner visits and higher prevalence of pneumococcal vaccination (p for linear trend <0.001). Conclusion Uptake of influenza and particularly of pneumococcal vaccination in this population of European multimorbid older inpatients remains insufficient and is determined by comorbidities and number and type of health care contacts, especially outpatient medical visits. Hospitalization may be an opportunity to promote vaccination, particularly targeting patients with few outpatient physician contacts.

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Section: Discussionmentioning

confidence: 97%

Cross-sectional study on the prevalence of influenza and pneumococcal vaccination and its association with health conditions and risk factors among hospitalized multimorbid older patients

et al. 2021

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“…Further high-quality RCTs are needed to develop successful maternal influenza vaccination programs. Level II McFadden & Seale 17 (2021) High-income countries (the USA, Australia, Canada) A narrative review of hospital-based strategies in acute care settings aimed at improving influenza vaccination rates for adult inpatients. Systematic review Included 31 studies 6 RCTs 6 non-RCTs 11 pre-post studies 8 cross-sectional Hospital settings 7 standing order protocols (SOP); 4 reminders; 4 assessment/administration programs; 1 patient education program; 1 organizational-based program; 7 multi-component strategies and 8 studies comparing SOPs with other strategies.…”

Section: Methodsmentioning

confidence: 99%

“…12 One-off provision of guidelines to physicians, and to both physicians and nurses, significantly improved influenza vaccination rates by an average 24% in adult patients (23.8%, 95% CI:15.7-31.8%; three observational studies) and pediatric patients (24%, 95% CI: 8.1-39.9%; two observational studies). 12 A systematic review 17 (included 31 studies) of hospitalbased strategies in acute care settings aimed at improving influenza vaccination rates for adult inpatients showed that standing order protocols were significantly more effective than other individual interventions, but multi-component interventions (which included standing order protocols) were more effective than standing order protocols alone. Isenor etal.…”

Section: (Iii) Pregnant Womenmentioning

confidence: 99%

A rapid global review of strategies to improve influenza vaccination uptake in Australia

Mohammed

McMillan

Elliott

et al. 2021

Human Vaccines & Immunotherapeutics

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This study aimed to identify effective strategies for improving the uptake of influenza vaccination and to inform recommendations for influenza vaccination programs in Australia. A rapid systematic review was conducted to assimilate and synthesize peer-reviewed articles identified in PubMed. The National Health and Medical Research Council (NHMRC) Hierarchy of Evidence was used to appraise the quality of evidence. A systematic search identified 4373 articles and 52 that met the inclusion criteria were included. The evidence suggests influenza vaccination uptake may be improved by interventions that (1) increase community/patient demand and access to influenza vaccine and overcome practice-related barriers; (2) reinforce the critical role healthcare providers play in driving influenza vaccination uptake. Strategies such as standing orders, reminder and recall efforts were successful in improving influenza vaccination rates. Community pharmacies, particularly in regional/remote areas, are well positioned to improve influenza vaccine coverage. The findings of this rapid review can be utilized to improve the performance of influenza immunization programs in Australia and other countries with comparable programs; and recommend priorities for future evaluation of interventions to improve influenza vaccination uptake.

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“…Our earlier work indicates the potential for hospital-based interventions for improving opportunistic inpatient vaccinations (9). However, currently, hospitals are currently be underutilised in Australian for adult vaccination, despite the willingness of the public to receive vaccinations in this setting (10).…”

Section: Introductionmentioning

confidence: 94%

The Pendulum Has Swung: How Do We Ensure a Life Course Approach to Immunisation in Australia?

Seale

McFadden

Dyda

et al. 2022

Front. Public Health

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Rather than concentrating primarily on children and adolescents, there has been a shift in the discourse around immunisation to encompass a whole-of-life approach. Despite this acknowledgement and ongoing high burdens of vaccine preventable diseases in adults, coverage for some adult risk groups remains sub-optimal. This study aimed to explore key informant's and stakeholder's perceptions of factors impacting provision of immunisation programs for Australian adults and to identify strategies to promote acceptance and uptake. Semi-structured telephone interviews were undertaken with people involved in adult immunisation program delivery, advocacy, policy or research between September 2020 and June 2021. Transcripts were inductively analysed, with the resulting themes categorised into the five influences on vaccination gaps that have informed program planning in other countries: Access, Affordability, Awareness, Acceptance and Activation. Participants spoke of improvements in the provision of vaccines to adults, however, ongoing challenges persisted. Participants agreed that the focus or emphasis of policies and the promotion/communication strategies has been on childhood vaccination in Australia, however there is a sense that the “pendulum has swung.” These included understanding of eligibility amongst the Australian population and the reluctance of some health providers to dedicate time to exploring immunisation needs with adult patients. In comparison to the childhood vaccination program, there has been a lack of data available on coverage for adult vaccines on the national immunisation program. This has contributed to the ongoing challenges of identifying and promoting certain vaccines. At a government level, questions were raised about why the Australian government has never set an aspirational target for adult vaccination (i.e., influenza or pneumococcal) coverage. While significant improvements have been made in adult immunisation uptake, there are still gaps across the program. While the system remains under stress because of the COVID-19 pandemic, it is not appropriate to implement any additional programs. There needs to be strong commitment to establish the value of adult vaccination in the eyes of community members, policy makers and healthcare professionals. Having a national adult immunisation strategic plan would help advance action.

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A review of hospital-based interventions to improve inpatient influenza vaccination uptake for high-risk adults

Cited by 18 publications

References 48 publications

Cross-sectional study on the prevalence of influenza and pneumococcal vaccination and its association with health conditions and risk factors among hospitalized multimorbid older patients

Cross-sectional study on the prevalence of influenza and pneumococcal vaccination and its association with health conditions and risk factors among hospitalized multimorbid older patients

A rapid global review of strategies to improve influenza vaccination uptake in Australia

The Pendulum Has Swung: How Do We Ensure a Life Course Approach to Immunisation in Australia?

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