Clinical trial NCT03445117: Increasing the Uptake of Influenza and Pneumococcal Vaccines Among High-Risk Adult Patients Through GP Clinics
Official title: Increasing the Uptake of Influenza and Pneumococcal Vaccines Among High-Risk Adult Patients Through General Practitioner Clinics
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Immunization Programs
Keywords: Influenza Vaccines
Pneumococcal Vaccines
Primary Health Care
Health Communication
Cross-Over Studies
Randomized Controlled Trial
Lead sponsor: Tan Tock Seng Hospital
Sponsor class: OTHER
Collaborators: name: Frontier Healthcare Group
name: OneCare Medical Group
First posted: 2018-02-26
Enrollment: 8837
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: two-arm cluster randomised crossover trial
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

Eligibility criteria: 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

Primary outcomes:
measure: Difference in influenza vaccination uptake rate for clinics between intervention and non-intervention periods
timeFrame: 8 months (post-study completion)
measure: Difference in pneumococcal vaccination uptake rate for clinics between intervention and non-intervention periods
timeFrame: 8 months (post-study completion)
Secondary outcomes:
Other outcomes:
Locations:
city: Singapore
country: Singapore
facility: Frontier Healthcare Group
city: Singapore
country: Singapore
facility: OneCare Medical Group
Study officials:
affiliation: Tan Tock Seng Hospital
name: Dr Hanley Ho
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ho HJ, Tan YR, Cook AR, Koh G, Tham TY, Anwar E, Hui Chiang GS, Lwin MO, Chen MI. Increasing Influenza and Pneumococcal Vaccination Uptake in Seniors Using Point-of-Care Informational Interventions in Primary Care in Singapore: A Pragmatic, Cluster-Randomized Crossover Trial. Am J Public Health. 2019 Dec;109(12):1776-1783. doi: 10.2105/AJPH.2019.305328. Epub 2019 Oct 17.