Evidence-based interventions cause multifold increase of influenza immunization rates in a free clinic

Evaluation of a team-based quality improvement initiative for influenza vaccination in an underserved population

BACKGROUND

Influenza vaccine is the most effective way to prevent influenza. However, low vaccination rates continue especially in underserved populations.

OBJECTIVES

To increase influenza vaccinations in an underserved population and to evaluate the impact of influenza vaccinations compared to previous year influenza vaccinations.

PRACTICE DESCRIPTION

Federally-Qualified Health care Center for the Homeless, Richmond, Virginia PRACTICE INNOVATION: Team-based quality improvement initiative led by a pharmacist champion.

EVALUATION METHODS

Before and after evaluation of the quality improvement initiative was conducted by comparing the total number of vaccines administered to those administered the previous year.

RESULTS

Influenza vaccinations increased by 42% over the prior influenza vaccination season (1269 vs. 895), respectively. From a population perspective, 31% of patients received an influenza vaccine in 2019-20 and 48% in 2020-21. During the 2019-20 influenza vaccine season, the majority of patients vaccinated were female 56% versus 50.9% in 2020-21. The average age increased from 2019-20 to 2020-21, 37.62 years of age versus 42.71 years of age, respectively.

CONCLUSION

A team-based quality improvement initiative was successful in improving our influenza vaccination program for adults and has served as a foundation for the delivery of other vaccines. Lessons learned were used to implement a COVID-19 vaccine program.

Influenza and Influenza Vaccine: A Review

Influenza is a highly contagious, deadly virus, killing nearly half a million people yearly worldwide. The classic symptoms of influenza are fever, fatigue, cough, and body aches. In the outpatient setting, diagnosis can be made by clinical presentation with optional confirmatory diagnostic testing. Antiviral medications should be initiated as soon as possible, preferably within 24 hours of initiation of symptoms. The primary preventive measure against influenza is vaccination, which is recommended for all people 6 months of age or older, including pregnant and postpartum women, unless the individual has a contraindication. Vaccination should occur at the beginning of flu season, which typically begins in October. It takes approximately 14 days after vaccination for a healthy adult to reach peak antibody protection. There are challenges associated with vaccine composition and vaccine uptake. It takes approximately 6 to 8 months to identify and predict which influenza strains to include in the upcoming season's vaccine. During this time, the influenza virus may undergo antigenic drift, that is, mutating to avoid a host immune response. Antigenic drift makes the vaccine less effective in some seasons. The influenza virus occasionally undergoes antigenic shift, in which it changes to a novel virus, creating potential for a pandemic. There are also barriers to vaccine uptake, including lack of or limited access to care and misconceptions about receiving the vaccine. Interventions that improve access to and uptake of the influenza vaccine must be initiated, targeting multiple levels, including health care policy, patients, health care systems, and the health care team. This article reviews information about influenza identification, management, and prevention.