How to develop a program to increase influenza vaccine uptake among workers in health care settings?

Background: Apart from direct protection and reduced productivity loss during epidemics, the main reason to immunize healthcare workers (HCWs) against influenza is to provide indirect protection of frail patients through reduced transmission in healthcare settings. Because the vaccine uptake among HCWs remains far below the health objectives, systematic programs are needed to take full advantage of such vaccination. In an earlier report, we showed a mean 9% increase of vaccine uptake among HCWs in nursing homes that implemented a systematic program compared with control homes, with higher rates in those homes that implemented more program elements. Here, we report in detail the process of the development of the implementation program to enable researchers and practitioners to develop intervention programs tailored to their setting. Methods: We applied the intervention mapping (IM) method to develop a theory-and evidence-based intervention program to change vaccination behaviour among HCWs in nursing homes. Results: After a comprehensive needs assessment, we were able to specify proximal program objectives and selected methods and strategies for inducing behavioural change. By consensus, we decided on planning of three main program components, i.e., an outreach visit to all nursing homes, plenary information meetings, and the appointment of a program coordinator - preferably a physician - in each home. Finally, we planned program adoption, implementation, and evaluation. Conclusion: The IM methodology resulted in a systematic, comprehensive, and transparent procedure of program development. A potentially effective intervention program to change influenza vaccination behaviour among HCWs was developed, and its impact was assessed in a clustered randomised controlled trial

The impact of the new Dutch guideline on cardiovascular risk management in patients with COPD: a retrospective study

Background: Patients with chronic obstructive pulmonary disease (COPD) have an independent increased risk of cardiovascular (CV) disease. Cardiovascular risk (CVR) assessment should be offered to all patients with COPD, according to the new Dutch CVR management (CVRM) guideline (May 2019). Aim: To evaluate the impact of the new CVRM guideline on the care of patients with COPD in primary care. Design & setting: A retrospective study took place within five primary healthcare centres located in The Netherlands. Method: In accordance with the guideline, the CVR of all patients with COPD was estimated and categorised. Data from 2014–2019 were used for the qualitative risk assessment based on comorbidities, and the quantitative Systematic Coronary Risk Evaluation (SCORE). In addition, the guideline-based follow-up was investigated. Results: Of the 391 patients with COPD, 84.1% (n = 329) had complete data on CVR assessment: 90.3% (n = 297) had a (very) high risk, and 9.7% (n = 32) a low-to-moderate risk. Of the patients with (very) high risk, 73.4% (n = 218) received guideline-based follow-up (primary care: 95.4%, secondary care: 4.6%). In 15.9% (n = 62) of all patients with COPD, the CVR profile was not measured and of the (very) high-risk patients, 26.6% (n = 79) were not enroled in a CV care programme. Conclusion: Whereas in the majority of patients with COPD the CVR is already known, for one out of six patients this CVR still has to be assessed according to the recently updated guideline. Moreover, once a (very) high risk has been assessed, as a consequence CV treatment of risk factors should be intensified in one out of four patients with COPD. Adherence to the new CVRM guideline could prvide improvement in CVRM in more than a third of all patients with COPD

Comparing the diagnostic considerations between general practitioners with a special interest in cardiovascular disease and those without in patients with symptoms suggestive of heart failure: a vignette study

Background: General practitioners (GPs) specialized in cardiovascular disease (GPSI-CVD) may suspect heart failure (HF) more easily than GPs not specialized in CVD. We assessed whether GPSI-CVD consider investigations aimed at detecting HF more often than other GPs in two clinical scenarios of an older male person with respiratory and suggestive HF symptoms. Methods: In this vignette study, Dutch GPs evaluated two vignettes. The first involved a 72-year-old man with hypertension and a 30 pack-year smoking history who presented himself with symptoms of a common cold, but also shortness of breath, reduced exercise tolerance, and signs of fluid overload. The second vignette was similar but now the 72-year-old man was known with chronic obstructive pulmonary disease (COPD). GPs could select diagnostic tests from a multiple-choice list with answer options targeted at HF, COPD or exacerbation of COPD, or lower respiratory tract infection. With Pearson Chi-square or Fisher’s exact test differences between the two GP groups were assessed regarding the chosen diagnostic tests. Results: Of the 148 participating GPs, 25 were GPSI-CVD and 123 were other GPs. In the first vignette, GPSI-CVD more often considered performing electrocardiography (ECG) than other GPs (64.0% vs. 32.5%, p = 0.003). In the second vignette, GPSI-CVD were more inclined to perform both ECG (36.0% vs. 12.2%, p = 0.003) and natriuretic peptide testing (56.0% vs. 32.5%, p = 0.006). Conclusions: Most GPs seemed to consider multiple diagnoses, including HF, with GPSI-CVD more likely performing ECG and natriuretic peptide testing in an older male person with both respiratory and suggestive HF symptoms

Influenza vaccination in nursing home health care workers: The current situation

Aim: To examine if the NVVA guideline: "Influenza prevention in Nursing homes and Homes for the elderly" has resulted in changes in vaccination policy and vaccination rate among personnel. Method: Dutch nursing homes (n=335) have been asked to fill in a questionnaire. In this questionnaire there has been asked for the vaccination rate (2004), request manner, presence of a written policy and manner of informing; all concerning influenza vaccination of personnel. Results: 149 homes (45%) reported an average vaccination rate among personnel of 10.5%, 45% of these have a written policy and in 72% there is an active request The vaccination rate is higher when both of these are present. Conclusion: The guideline has resulted in a slight increase of the vaccination rate among nursing home personnel (from 5-8% to 10.5%). Nursing homes with a written policy have more often switched to on an active request Further improvement of influenza vaccination campaigns is necessary

Influenzavaccinatie bij verpleeghuispersoneel: De stand van zaken

Aim: To examine if the NVVA guideline: "Influenza prevention in Nursing homes and Homes for the elderly" has resulted in changes in vaccination policy and vaccination rate among personnel. Method: Dutch nursing homes (n=335) have been asked to fill in a questionnaire. In this questionnaire there has been asked for the vaccination rate (2004), request manner, presence of a written policy and manner of informing; all concerning influenza vaccination of personnel. Results: 149 homes (45%) reported an average vaccination rate among personnel of 10.5%, 45% of these have a written policy and in 72% there is an active request The vaccination rate is higher when both of these are present. Conclusion: The guideline has resulted in a slight increase of the vaccination rate among nursing home personnel (from 5-8% to 10.5%). Nursing homes with a written policy have more often switched to on an active request Further improvement of influenza vaccination campaigns is necessary