1. Collection of influenza immunisation uptake data from General Practices Simon Cottrell, Public Health Wales Communicable Disease Surveillance Centre and Vaccine Preventable Disease Programme

2. Acknowledgements Thanks to: General Practices
Health Board Immunisation Coordinators
NWIS Primary Care Informatics Team (PCIT)
Public Health Wales Vaccine Preventable Disease Programme
Public Health Wales Communicable Disease Surveillance Centre
Surveillance using Audit+

3. Flu immunisation in Wales
High burden of disease caused by influenza
Free vaccination available for: 65y and older, clinical risk groups, pregnant women, 2 to 7 year olds, health and social care staff, carers and those in long stay care
Targets:
75% uptake in 65y+ and clinical risk groups
50% in NHS staff
Excess seasonal mortality in UK in 2014/15 – 16,000+
In European region up to 50 million flu cases annually, estimated between 15,000 and 70,000 deaths annually
Places a substantial burden on health care services
75% target, suggested by WHO based on reducing transmission. Very challenging with few countries in Europe achieving it.
50% uptake in staff a more achievable operational target (will increase in future)
Surveillance using Audit+

4. Flu immunisation in Wales
This is where we are the moment.
One of the highest uptakes in Europe (although lowest in the UK in many areas), but only achieving target for pregnant women.
Front-line NHS staff: 47.3%
Surveillance using Audit+

5. Collection of flu immunisation uptake data
2003: Taken on by NPHS, paper-based questionnaire, chase-up by immunisation coordinators (80% response rate)
2004/5: Semi-automated collection through MSD Clinical Audit (91% response rate), one-off collection in March/ April
2007/8: First automated collection through Audit+ (85% response rate), one-off collection in April
2015/16: Automated weekly data collection using Audit+, end of season response rate 100%
Surveillance using Audit+

6. Who uses Audit+ surveillance reports produced by Public Health Wales?
Practices
Health Boards
Public Health Wales
Local Public Health Teams
Welsh Government
PHE for UK reports
ECDC (European Communicable Disease Control)
WHO
A variety of people use the surveillance reports which Public Health Wales produces using data collected from General Practices.
Surveillance using Audit+

7. How Audit+ data is collected
Data quality
Audit+
Consultation
GP database
Read code
GP surv module
Adult Imms module
Other modules
Public Health Wales Health Protection
Routine disease surveillance
Vaccination surveillance
Monitoring PH emergencies
Monitoring mass gatherings
Aggregate data
Other users
e.g. SAIL
Dis/aggregate data
NWIS PCIT
Manage Audit+. Author searches.
Informatica
Technical. Deploy modules/ searches
This is a simplified diagram to show how the surveillance data which is used by Public Health Wales is collected.
Diagnoses and treatments in General Practices are entered on to the practice database, using appropriate Read codes. The Audit+ software is able to search the practice database for Read codes which have been specified beforehand by Public Health Wales and NWIS PCIT; and send the relevant, anonymous data to Public Health Wales CDSC to be analysed and reported back as disease rates, vaccine uptake rates, etc.
Others also use data collected using Audit+ (e.g. SAIL for academic research purposes).
Surveillance using Audit+

8. Data collected by PHW CDSC and VPDP
Consultation data (eg’s) Flu-like illness
gastroenteritis
heatstroke
chicken pox
Vaccination uptake data
Influenza
Shingles
Pneumococcal
MenACWY
Surveillance using Audit+

9. Flu immunisations, which data?
Policy
Read code specifications
JCVI
Audit + data collection requirements
Surveillance
Surveillance using Audit+

10. Reporting influenza immunisation uptake data
End of season report
Influenza Vaccination Online Reporting (IVOR)
Operationally useful real-time reports for: GPs, HBs, PHW and WG
Weekly reports at:
Health board level
LA level
Cluster level
Practice level
Surveillance using Audit+

11. IVOR
Surveillance using Audit+

12. IVOR
Surveillance using Audit+

13. Weekly analysis Surveillance using Audit+
We collect data and monitor the uptake of flu immunisation uptake throughout the flu season. In this way we can see how many people have been vaccinated before the virus starts to circulate in the community.
Surveillance using Audit+

14. Weekly analysis Surveillance using Audit+
This chart shows weekly flu immunisation uptake in patients aged 65y and older in more detail. It is a box and whisker plot, which shows the spread of uptake in General Practices reported each week through Audit+. The centre line in each of the blue boxes is the median (average) of practice level uptakes that were reported through Audit+ that week. The box shows the spread of the central 50% of practice level uptakes and the whiskers show you the approximately the central 95% spread of uptake in general practices. The dots are outlier practices, where uptake is either unusually low or unusually high.
Monitoring practice level uptake throughout the season is important, because it lets us identify where there may be issues with practices not being able to submit using Audit+ or where there is something affecting the quality of data coming in from some practices. The outliers circled in red are practices where there were issues affecting data quality, using the practice level data throughout the season allowed us identify issues and allowed the Primary Care Informatics Team to target help and advice to practices to rectify any issues.
Surveillance using Audit+

15. Data quality and interpreting reports
Weekly reports, weekly queries on data quality
Most reported data quality issues weren’t
Investment needed in training for data users on interpretation
Increased use and understanding of reports leads to better data quality
Useful feedback from data users and advice on encouraging use of reports
Requests for weekly reporting of uptake arose from GP, HB, PHW and WG.
In addition to meeting demand, weekly reporting allows us to investigate and maintain data quality.
Gather feedback and advice on usefulness and appropriateness of reports.
Help service users understand and interpret the reports.
Surveillance using Audit+

16. 100 patients aged 65y and older at the start of the campaign
10 patients are contraindicated
13 patients decline when invited
59 patients are immunised
So what is the uptake?
59/90 x 100 = 65.5%
59/77 x 100 = 76.6%
59/100 X 100 = 59%
Set in place training for general practices and health boards on use and interpretation the data.
Things that we take for granted as simple often turn out to be more complicated for others in the process.

17. Useful links
Further information on Public Health Wales surveillance of flu immunisation uptake using Audit+:
Public Health Wales bulletins and reports
CDSC weekly flu surveillance report:
CDSC weekly GP newsletter:
VPDP monthly immunisation e-bulletin
Sign-up to receive notifications of updates on immunisations:
Surveillance using Audit+

18. Thank you Questions?
Surveillance using Audit+