Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice

Abstract

Objective: To identify practice strategies associated with higher flu vaccination rates in primary care.

Design: Logistic regression analysis of data from a cross-sectional online questionnaire.

Setting: 795 general practices across England.

Participants: 569 practice managers, 335 nursing staff and 107 general practitioners.

Primary outcome measures: Flu vaccination rates achieved by each practice in different groups of at-risk patients.

Results: 7 independent factors associated with higher vaccine uptake were identified. Having a lead staff member for planning the flu campaign and producing a written report of practice performance predicted an 8% higher vaccination rate for at-risk patients aged <65 years (OR 1.37, 95% CI 1.10 to 1.71). These strategies, plus sending a personal invitation to all eligible patients and only stopping vaccination when Quality and Outcomes Framework targets are reached, predicted a 7% higher vaccination rate (OR 1.45, 95% CI 1.10 to 1.92) in patients aged ≥65 years. Using a lead member of staff for identifying eligible patients, with either a modified manufacturer's or in-house search programme for interrogating the practice IT system, independently predicted a 4% higher vaccination rate in patients aged ≥65 years (OR 1.22, 95% CI 1.06 to 1.41/OR 1.20, 95% CI 1.03 to 1.40). The provision of flu vaccine by midwives was associated with a 4% higher vaccination rate in pregnant women (OR 1.19, 95% CI 1.02 to 1.40).

Conclusions: Clear leadership, effective communication about performance and methods used to identify and contact eligible patients were independently associated with significantly higher rates of flu vaccination. Financial targets appear to incentivise practices to work harder to maximise seasonal influenza vaccine uptake. The strategies identified here could help primary care providers to substantially increase their seasonal flu vaccination rates towards or even above the Chief Medical Officer's targets.

Figure 1

Box and whisker plots showing the range and distribution of influenza vaccination uptake rates for patients aged 65+ years (blue boxes and bars) and at-risk patients aged under 65 years (red boxes and bars). The distribution of uptake rates for non-participating practices (N=2101) and participating practices (N=795) are not significantly different.

Figure 2

(A) Relationship between reported total number of vaccine doses ordered for the 2011–2012 season and actual number of doses administered in 2010–2011 (n=568) and (B) plot showing the maximum average achievable vaccination rates for the 2011–2012 season, based on the total number of vaccine doses ordered and the total number of eligible patients. Red line indicates the Chief Medical Officer's target of 75%.

Figure 3

Showing (A) the reported activity of community midwifery teams in recommending and providing seasonal influenza vaccination to pregnant women and (B) the attitudes of participating healthcare workers to vaccination of colleagues and themselves.