Increasing the Uptake of Influenza and Pneumococcal Vaccines Among High-Risk Adult Patients Through GP Clinics

Not Applicable

Completed

• Conditions: Immunization Programs
• Interventions: Other: Educational intervention

• Registration Number: NCT03445117
• Lead Sponsor: Tan Tock Seng Hospital

Brief Summary

Pneumonia and influenza are among the top causes of hospitalisation and death in the elderly. While vaccinations are recommended against these diseases, a large proportion of elderly in the community remain unvaccinated, with approximately only 10% vaccinated for either disease. In this study, the investigators aim to implement an intervention package within GP clinics to increase influenza and pneumococcal vaccination rates, especially among elderly patients with chronic diseases.

Detailed Description

Influenza and pneumococcal disease contribute considerably to hospitalisation and mortality in the elderly. While recommended vaccines can reduce disease burden, vaccine uptake remains very low in Singapore, with approximately only 10% of elderly appropriately vaccinated for either disease. Improving vaccine uptake rates could be effected through private sector primary care clinics, which are highly accessible in Singapore. An intervention bundle we piloted in one clinic comprised physician reminders and patient-targeted posters and brochures. Influenza and pneumococcal vaccine rates both increased by \>30% over the baseline, although half of eligible patients remained unvaccinated. There is thus scope to devise a more effective intervention bundle and demonstrate its efficacy through a more robust and generalisable study design.

This study aims to evaluate the efficacy of an intervention bundle deployed in general practice clinics to promote influenza and pneumococcal vaccine uptake among elderly patients. The intervention bundle components include educational materials such as posters and flyers, which also serve as reminder slips for attending physicians. The intervention will be implemented in a two-arm cluster randomised crossover trial in up to 30 primary care clinics. Control arm clinics will receive no interventions. Clinics will be randomised into either of the two arms for a period of 3 months, followed by a washout of 1 month before a crossover is performed. The investigators will subsequently compare vaccination rates during intervention and control periods to provide evidence for effectiveness of the intervention.

Study Timeline

• Study Start: 2017-11-01
• Study First Submitted: 2018-01-28
• Study First Submitted QC: 2018-02-19
• Study First Posted: 2018-02-26
• Primary Completion: 2018-07-31
• Study Completion: 2018-07-31
• Status Verified: 2019-06
• Last Update Submitted: 2019-07-01
• Last Update Posted: 2019-07-05

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 8837

Inclusion Criteria

• Patients seen at GP clinics involved in our study AND
• Aged 65 years and above, with or without chronic disease

Exclusion Criteria

• Patients not seen at GP clinics involved in our study
• Patients aged below 65 years old

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Intervention	Educational intervention	Clinics assigned to the intervention arm will receive an educational intervention. This comprises posters on vaccination to be put up in the clinic, as well as a flyer which will be handed out by the clinic assistants to all patients 65 years and above, at the point of registration. The poster and flyer content will provide simple messaging to encourage patients to receive influenza and pneumococcal vaccinations and inform them of available healthcare subsidies.

Primary Outcome Measures

Name	Time	Method
Difference in influenza vaccination uptake rate for clinics between intervention and non-intervention periods	8 months (post-study completion)	The proportion of all eligible patients arriving at each clinic who receive influenza vaccine during the intervention period compared to the non-intervention period for each clinic.
Difference in pneumococcal vaccination uptake rate for clinics between intervention and non-intervention periods	8 months (post-study completion)	The proportion of all eligible patients arriving at each clinic who receive pneumococcal vaccine during the intervention period compared to the non-intervention period for each clinic.

Trial Locations

Locations (2)

Frontier Healthcare Group; 🇸🇬 Singapore, Singapore

OneCare Medical Group; 🇸🇬 Singapore, Singapore