Abstract

Background. Influenza and pneumococcal vaccinations are important therapies supported by national and international guidelines for preventing morbidity and mortality from respiratory illnesses in high-risk groups. The responsibility for delivering these vaccinations in the United Kingdom lies with primary care. Little is known about how rates of influenza and pneumococcal vaccination can be increased in high-risk groups in primary care.
Aim. To research methods of improving rates of influenza and pneumococcal vaccination in high-risk groups in primary care.
Objectives. To investigate the impact of educational interventions for primary care teams on influenza and pneumococcal vaccination rates in high-risk groups.
Method. The research had the following components:
a. Literature search examining current practice and policy in relation to influenza and pneumococcal vaccination and studies undertaken to improve performance, both in general and specifically in relation to improving adult vaccination rates.
b. Pilot study of targeting influenza and pneumococcal vaccination to high-risk groups in a single general practice.
c. Effect of audit and feedback with an information pack to primary care teams on influenza and pneumococcal vaccination in primary care: before-and-after multipractice study.
d. Effect of audit and feedback with an information pack to primary care teams, as part of a clinical governance programme, on influenza and pneumococcal vaccination in a primary care trust: before-and-after multipractice study.
e. Randomised controlled study of an educational outreach intervention partly nested within primary care trust study with audit, feedback and information (passive dissemination of guidelines and recommendations) directed at primary health care teams compared with audit feedback and information alone using multifaceted interventions to increase influenza and pneumococcal vaccine uptake in high-risk groups in primary care.
Results. The studies demonstrated significant improvements in influenza and pneumococcal vaccination rate in high-risk groups in primary care, showed the levels of improvement that could be expected from these types of intervention and described how primary care teams responded to direct and indirect educational interventions supported by measurement of performance.
Conclusions. Education to multiprofessional teams is an important method for diffusion of innovations in the highly professionalised organisations of primary care and general practice. Educators need to understand the complex nature of primary care organisations and teams, when and how education for teams is likely to be successful, the barriers to implementation of new ideas and how to address these. Education when applied appropriately can have important effects in improving health care. This is more likely to occur when careful assessments are made around the nature of the evidence, clear outcomes are sought and measured and the healthcare intervention is understood from the perspective of the patient, the healthcare team and other stakeholders.