KNAW

Research

Development and evaluation of influenza vaccination implementation program...

Pagina-navigatie:


Update content


Title Development and evaluation of influenza vaccination implementation program for health care workers in nursing homes
Period 09 / 2005 - unknown
Status Completed
Research number OND1317903
Data Supplier ZonMw

Abstract

Implementation of influenza vaccination programs for health care workers (HCWs) in contact with high-risk people has been encouraged by the WHO. Influenza vaccination of healthy workers has been shown to reduce mortality amongst residents of health care institutions. Furthermore, some studies have shown cost-effectiveness and even cost-savings of such programs from a societal perspective. The Netherlands Society for Nursing Home Physicians (NVVA) therefore will issue an influenza guideline with regard to vaccinating both patients and HCWs in nursing homes in the year 2004. This research proposal focuses on the development and evaluation of an implementation program targeting influenza vaccination to HCWs in nursing homes. The proposed three-stage study will first aim at developing the intervention using qualitative and quantitative information from HCWs working in nursing homes and other relevant stakeholders. Similar to the successful National Prevention program among GPs, we will address potential barriers and success factors both from a person and organisational perspective in the development phase using structured in-depth interviews and surveys amongst relevant stakeholders and a sample of HCWs. An advisory board will review the results of these analyses and define the optimal implementation strategy in consensus with the research team. The objective of the second part is to implement the developed vaccination program and evaluate the success of the program by means of a pragmatic randomized controlled trial. In this pragmatic trial approximately 15 nursing homes will be randomly allocated to the intervention group and 15 nursing homes will serve as the control group. The evaluation of the success of the program is aimed at the influenza vaccination rate of HCWs in nursing homes. Furthermore, the cost-effectiveness of the developed vaccination program among HCWs in a pragmatic setting will be evaluated. Outcome parameters for this analysis are both direct medical, i.e. occurrence of mortality and serious morbidity potentially related to influenza among the residents and indirect non-medical including productivity loss of HCWs. The third part of the study will focus on the dissemination of the implementation program nationwide. Predictors for success of the implementation program will be estimated and recommendations for nationwide implementation will be made in accordance with the influenza guideline of the NVVA. Also, financial and potential implications for other health care institutions as homes for the elderly or hospitals will be analysed. Finally, all results will be presented on a national symposium, involving all stakeholders and representatives of the government. Influenza is an acute infectious disease of the respiratory system caused by one of the influenza viruses. During an influenza breakout, on average 5%-20% of the population are infected with the influenza virus. Although in 50% of these infections the disease remains sub-clinical, influenza can pose a substantial threat to elderly people or other high-risk groups like immune-compromised patients, those with chronic cardiopulmonary, renal and/or metabolic diseases and residents of nursing homes. In agreement with the WHO recommendation of 2000, the Dutch influenza vaccination program recommends vaccination for all people of 65 years and older and other high-risk groups. Recent research performed in assignment by the Dutch Health Care Insurance Board (CVZ) showed that 22% of the Dutch population qualify for the influenza vaccination and more than fifty percent of those consist of persons of 65 years or older(1). The Dutch influenza vaccination program has resulted in vaccination rate of 71% of the low-risk elderly population and 86% of the high-risk elderly population and has been proven to be cost-effective: 592 per life year gained for low-risk elderly population and 1.427 for high-risk elderly population(1). On September the 2nd of 2003, the WHO officially welcomed the initiatives of countries to also administer influenza vaccination to health care workers (HCWs) in contact with high-risk persons(2). This recommendation was made in the context of the concerns about SARS: the recent global outbreaks of SARS have heightened concerns about the occurrence of respiratory diseases having symptoms similar to those seen in SARS. Moreover, other benefits of influenza vaccination for HCW also justify its implementation: 1) reduction of productivity loss of the HCWs and 2) the benefits for the residents in the health care institutions. A recent systematic review has shown that from a pharmacoeconomic point of view, influenza vaccination of healthy working adults in the Western countries can be recommended(3). Vaccination of the HCWs appears to be cost-effective and even cost-saving from a societal perspective, including indirect benefits and costs of production losses/gains. Further, vaccination of HCWs has shown to reduce total mortality of residents of health care institutions and might also be cost-saving (4,5). Although the causal relation is still argued by some(6), in Canada the NACI (National Advisory Committee on Immunization) has recommended This proposal focuses on the development and evaluation of an implementation program for influenza vaccination among HCWs in nursing homes. The study will consist of 3 parts. The objective of the first part is to develop an implementation program for influenza vaccinations for HCWs in nursing homes. This implementation program should parallel the guideline for influenza vaccination in nursing homes, which is being developed currently by the NVVA with assistance of CBO. The objective of the second part of the study is to implement the vaccination program and evaluate the success of the program by means of a pragmatic randomized controlled trial. In this pragmatic trial 15 nursing homes will be randomized to a group implementing the developed program and 15 nursing homes will be randomized to a control group without following the developed implementation strategy. The intermediate aim is to achieve a vaccination rate of the HCWs in the implementation group of at least 71%, like the vaccination rate achieved currently amongst the low-risk elderly(1). The effect of the implementation program will ultimately be evaluated by assessing the (cost)-effectiveness of vaccinating HCWs in a pragmatic setting. The effects on mortality and morbidity (influenza related complications) of the residents and the effect on the productivity loss of the HCWs will be used as outcomes. The third part of the study will focus on the dissemination of the implementation program nationwide. Predictors for success of the implementation program will be estimated and recommendations for nationwide implementation will be made. Also budget impact analyses and generalization of the observations to other institutions (like homes for the elderly) will be conducted. In 2001, 333 nursing homes were registered in the Netherlands with a capacity for about 59,610 residents and employment of 82,960 people with patient-related functions(10). Under the condition that the composition of the vaccine used matches the virus strain causing the outbreak, about 70-90 % (11), of the vaccinated persons are adequately protected. However, in the elderly population this percentage is usually much lower and estimated at 50% (12). Therefore, a substantial part of the elderly population will not be protected adequately despite the high vaccination rate achieved by the Dutch influenza vaccination program. Grouping elderly people in institutions can create an environment that facilitates the rapid spread of influenza. Consequently, outbreaks of influenza still occur in care facilities(7). Moreover, studies have shown that mortality rates are at least twice as high in nursing homes as the rates amongst community-dwelling elderly with medical conditions (in the PRISMA study a mortality rate of 1.8% was found for the Dutch setting(13)). Monto et al.14 found in a cohort of nursing home patients in the US a mortality rate of 3.5% in the vaccinated population and 4.5% in the unvaccinated population. Taking in mind the fact that nursing homes in the US mostly also reside elderly that in the Netherlands would live in homes for the elderly, the risk of mortality will most probably be more than twice the risk of community-dwelling elderly persons. Part 1: development of the implementation program
To be able to develop a successful implementation program for influenza vaccination of HCWs in nursing homes, potential barriers and success factors for compliance should be assessed before hand. First, structured in-depth interviews with representatives of the involved stakeholders will be held. Concerning influenza vaccination of HCWs the following stakeholders will be involved: 1) the organisations of the nursing homes, represented by the Dutch branch organisation for nursing homes and homes for the elderly Acares; 2) nursing home physicians, represented by the Netherlands Society for Nursing Homes Physicians (NVVA); 3) nursing home nurses and care assistants, represented by the Dutch association for nurses and care assistants (AVVV); 4) health insurance companies and 5) Dutch public health authorities, like the LCI (National coordination structure for infectious diseases control, an organisation linked between the State and municipalities) and the CVZ (Dutch health care insurance board).

Related organisations

Related people

Researcher Drs. K. Bruynesteyn
Project leader Prof.dr. M.J.M. Bonten
Project leader Prof.dr. E. Hak

Classification

A70000 Public health and health care
D23110 Infections, parasitology
D23390 Occupational medicine
D24200 Health education, prevention

Go to page top
Go back to contents
Go back to site navigation