IMPROVING INFLUENZA VACCINE COVERAGE

FOR ELIGIBLE 0-4 YEAR OLDS INAUCKLAND AND WAITEMATA DHBS

Dr Catherine Jackson

Public Health Physician

Auckland and Waitemata DHBs

On behalf of Georgina Tucker, Kim McRae,

Michael Walsh, Natalie Desmond, Catherine Jackson

2

6 QUESTIONS OF QI

• Why?

• What?

• Who?

• How?

• What happened?

• What Next?

3

SYSTEM LEVEL MEASURES FRAMEWORK 2016

• High level aspirational goals

• Nationally set measures locally determined activities

• Outcomes focused

• Focus on equity gaps

• Promote sector wide collaboration

• Improvement methodology

• Results Based Accountability – Collective Impact

4

6 SYSTEM LEVEL MEASURES

Ambulatory Sensitive Hospitalisations 0-4

Keeping children out of hospital

Acute Hospital Bed Days

Using health resources effectively

Amenable Mortality Prevention and early detection

Patient Experience of Care

Person centred

Babies in SmokefreeHomes Healthy start to life

Youth Access to and Utilisation of care

Youth are healthy, safe and supported

5

AMBULATORY SENSITIVE HOSPITALISATIONS IN 0-4 YEAR OLDS

• Potentially preventable via preventative and therapeutic interventions deliverable in a primary care setting

• 30% of all admissions in 0-4 year olds

• Respiratory admissions contribute the most to ASH and include

• Asthma and wheeze

• Bronchiectasis

• Pneumonia

• Other lower respiratory infections

• Upper and ENT respiratory infections

6

ASH RATE PER 100 IN 0-4 YEAR OLDSAUCKLAND AND WAITEMATA DHB

0

1

2

3

4

5

6

7

8

9

10

2014

2015

2016

2017

2018

2014

2015

2016

2017

2018

2014

2015

2016

2017

2018

2014

2015

2016

2017

2018

Dental Dermatological Gastrointestinal Respiratory

Rat

e pe

r 10

0

Maori Pacific Other

EQUITY GAP

7

FOCUSSED ON ACTIVITIES TO REDUCE RESPIRATORY ADMISSIONS

• 8 month Immunisation Coverage

• Antenatal Pertussis and Influenza Immunisation

• 0-4 Influenza Vaccine for Eligible Children

• Smoking Cessation in Pregnant Women and their

Whanau

• Healthy Housing Referrals

8

INFLUENZA IN CHILDREN

• Flu infection rates are generally highest in children

• Healthy children are the major cause of the spread of influenza viruses in the community

• Immunising healthy children will help protect those immunised and their family

• Previously healthy children make up 50-60% of children who are hospitalised or die from influenza (Australia/USA) 0

50

100

150

200

250

300

<1 yo 1-4 yo 5-19 yo 20-34yo

35-49yo

50-64yo

65-79yo

>80 yo

Influenza Incidence 2018

Community

Hospital

9

CHILDHOOD FLU VACCINE APPROACHES

Country Policy Funded

New Zealand Eligible 0-4 year olds Targeted

Australia 0-4 year olds (2018)

Indigenous 0-4 year oldsUniversal in all but NTUniversal

UK 2-9 year olds Universal

USA 0-17 year olds Universal

10

NZ APPROACHWHICH 0-4 YEAR OLDS?

• Hospitalised for respiratory illness or have a history of significant respiratory illness (includes asthma on regular preventor)

• Children with an eligible medical condition (eligible for life) • Heart disease e.g. congenital or rheumatic heart disease• Chronic respiratory diseases• Diabetes• Chronic renal disease• Other conditions e.g. HIV, transplant recipients, celebral palsy,

children on long term aspirin, cochlear implant, Down syndrome, etc

• Free via Primary Care General Practices

https://www.influenza.org.nz/eligibility-criteria

11

ADHB / WDHB APPROACH

• Identified eligible ICD codes

• Identified eligible children – Hospital admission data

• Matched to primary care enrolment data to identify their primary care provider

• March: Provide each general practice with an excel file of their eligible children – sorted

• May: Match eligible cohort to NIR and provide updated list to practices

• June – Dec: Match eligible list to NIR to determine coverage and provide practice level updates in June, Sept, Dec

• Other activities – Eligibility on hospital discharge summaries, PHO activities – recall, promotion, CPD

12

LIMITATIONSOF

APPROACH

Defines a minimum eligible cohort (not on the list)

ICD coding accuracy

NIR data completeness

Reliance on manual systems

OUTCOMES

14

COVERAGE IS IMPROVING

0%

5%

10%

15%

20%

25%

30%

35%

AllianceHealth Plus

AucklandPHO

ComprehensiveCare

East HealthTrust

National HauoraCoalition

Procare TotalHealthcare

Cov

erag

e

Jul-17

Jul-18

Jun-19

15

PRACTICE LEVEL VARIATION SIGNIFICANT (2018 – PRACTICES WITH 15+ EL IG IBLE CHILDREN)

0

20

40

60

80

100

120

140

160

180

200

0%

10%

20%

30%

40%

50%

60%

70%

364

643

490

584

498

381

347

306

638

583

337

408

471

338

484

486

367

640

636

464

511

330

522

440

363

632

591

317

625

409

555

357

370

503

649

529

475

639

398

598

604

467

633

318

528

355

Cov

erag

e

% VaccinatedCohort size

Cohort Size

16

COVERAGE BY ETHNICITY

0%

5%

10%

15%

20%

25%

30%

Jul-17 Jul-18 Jun-19 Dec-18 Jul-17 Jul-18 Jun-19 Dec-18

Auckland DHB Waitemata DHB

Cov

erag

e

Asian

European/Other

Maori

Pacific

17

INTERNATIONAL COMPARISON

15.6

5.0

14.9

25.629.5

67.8

44.9

60.8

0

10

20

30

40

50

60

70

80

ADHB/WDHBEligible0-4 yo

AustraliaEligible

0-4 yo 2017

AustraliaIndigenous

20170-4 yo

Australia0-4 yo2018

AustraliaIndigenous0-4 yo 2018

USA0-4 yo

UK2-3 yo

UK4-9 yo

Targetted Universal

Cov

erag

e (%

)

18

IMPROVEMENT OPPORTUNITIES

• Review eligibility criteria – broaden to include other high risk children

• Centralised eligibility recording - NIR

• Improve access – other settings, DHB funded wider programmes – Maori and Pacific

• Monitor and report coverage

• Awareness raising for families / health care professionals

19

LAST THOUGHTS

• Room to improve coverage in young children – be aware of increasing equity gap

• Universal programmes improve coverage and are equity promoting

• Higher coverage is achievable with injectable influenza vaccine

• Universal Influenza Vaccine is Welcome Here

THANK YOU