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Improving influenza and pneumococcal vaccination uptake in high-risk groups in Lincolnshire: a quality improvement report from a large rural county

AN Siriwardena

Background: The delivery of in? uenza and pneumococcal vaccine to high-risk groups remains an important preventive care responsibility for primary care. There is a lack of evidence about in?fluenza and pneumococcal vaccination rates in high-risk groups in UK general practice and methods to improve this. Design Two-stage multipractice audit of in?fluenza and pneumococcal vaccination rates in high-risk groups before and after graphical anonymised feedback and written advice on improving vaccination rates. Setting 22 out of 105 Lincolnshire practices volunteered to participate. The study period for the baseline data collection was September to December 1998 and re-evaluation took place in January to February 2000 after the next annual in? uenza vaccination programme. Key measures for improvement In? uenza and pneumococcal vaccination rates in high-risk groups, speciŽ cally in patients with coronary heart disease, diabetes and post-splenectomy. Methods A combination of strategies for change were used including dissemination of guidelines, advice on setting up disease and vaccine registers, organisational strategies for improving vaccination rates including call and recall systems and benchmarking of performance.Results For practices participating in both phases of the audit cycle, mean annual in? uenza vaccination uptake increased by 10.8% (95% conŽ dence interval [CI] = 5.3% to 16.1%, P = 0.001) to 74.4% in coronary heart disease patients by 8.6% (CI = 1.5% to 15.7%, P = 0.02) to 70.6% in patients with diabetes and by 17.3% (CI = 4.8% to 29.8%, P = 0.01) in  post-splenectomy patients. Mean pneumococcal vaccination rates improved by 27.5% (CI = 12.6% to 42.3%, P = 0.002) to 58.6% in coronary heart disease patients by 28.8% (CI = 17.2% to 40.3%, P < 0.001) to 64.0% in patients with diabetes and by 15.9% (CI = 1.8% to 30.1%, P = 0.03) in post-splenectomy patients. These improvements occurred prior to the current national programme for in? uenza vaccination of patients over 65 years old. Conclusions Improvements in in? uenza and pneumococcal vaccination uptake occurred in patients with coronary heart disease, diabetes and post-splenectomy at re-evaluation. Practices were able to achieve and exceed national targets for in? uenza immunisation of high-risk groups. Quality of care improved through organisational change, audit and feedback with benchmarking of performance