Evaluation of strategies to increase vaccination coverage against influenza in people with one or more chronic diseases | INSPQ

This report presents the results of an evaluation project carried out in 2019-2020 in Quebec, in the context of the recommendations of the Ministry of Health and Social Services to prioritize, among others, people living with one or more chronic diseases. (PVMC) for vaccination against influenza (influenza). The but of the project is to explore the different strategies currently in place in Québec to rejoin and vaccinate against the flu in PVMC aged 18 to 74 years and, note, identify the optimal models for the organization of ces vaccination people. For this, an environmental exploration of those responsible for vaccination against influenza in the regional departments of public health (DSPubliques) of Quebec was carried out through semi-structured interviews. To better describe the vaccination offer, an in-depth analysis of the modes of organization of vaccination in vaccination settings (outpatient clinics, family medicine groups, hospitals) was carried out through interviews with vaccinating health professionals and field observations to analyze costs. associated with vaccination in specific settings. Finally, to describe the barriers and facilitators of the flu vaccination offer among PMCP, an online questionnaire was sent to health professionals (nurses, doctors and respiratory therapists) involved with these patients.

Results

• A total of 16 interviews were conducted with public officials of the DS;
• 13 interviews were conducted with immunization managers in specific settings to monitor PLWHV;
• Regarding the online questionnaire for health professionals, 197 doctors (general practitioners and specialists), 192 nurses and 183 respiratory therapists responded;
• The results of the interviews conducted with the 16 DSPubliques indicate that there are several problems in achieving the goal of 80% vaccination coverage among PLWHA. The main barriers include: the lack of material and human resources, the lack of time, the complexity of the vaccination registry, the difficulty of communicating with the network to implement strategies in specific scenarios, and the confusion regarding the roles of the actors involved. . in vaccination;
• In addition to vaccination in outpatient clinics, various strategies have been implemented in the regions to promote influenza vaccination of PVMC, such as the identification of patient care trajectories, the offer of vaccination by other health professionals who are not doctors or nurses (respiratory therapists and pharmacists), the grouping of care in the same physical environment, the increase in the collaboration of health professionals treating PLWHA, the reinforcement of the supervision of health professionals for vaccination in PLWHA with a care guide and training as well as advertising for patients;
• The in-depth analysis of the vaccinating communities showed three types of vaccination offers: systematic vaccination of patients with chronic diseases, opportunistic vaccination and referral of patients to other vaccination points;
• Despite the limitations of the cost analysis performed, the results suggest that the cost per vaccinated is lower in a family medicine group than in a hospital outpatient clinic. The costs are highly influenced by the time dedicated to the vaccination activity and by the type of professional who vaccinates;
• The results of the online questionnaire among professionals indicate that strategies to encourage/promote influenza vaccination already exist in most CVD care settings, such as the availability of posters or brochures and the advice. Most health professionals reported that they always or almost always recommended vaccination for specific patients. Barriers to vaccination are: lack of time and resources, hesitant patients to get vaccinated, and lack of tools to counsel patients.

recommendations

Although the 2018 flu vaccination campaign was a year of transition towards the implementation of the new recommendations of the Committee sur l’immunization du Québec and regular vaccination activities were to be maintained, initiatives have already been launched in some regions to try to better reach and vaccinate PVMC. Collaboration with key stakeholders appears to be an important facilitating factor for the implementation of such initiatives. Identifying the care pathways used by the PVMC makes it possible to implement strategies adapted to local contexts and offer vaccination in settings where these people are monitored and avoid multiple visits to different facilities. Various tools have also been developed for PVMC and to support practitioners. Communication and information strategies can improve vaccination coverage if combined with other strategies to facilitate access to vaccination services. Lastly, diversifying the vaccination offer with new professional vaccinators such as respiratory therapists or pharmacists could make it possible to reach more target groups.