making the flu vaccination service work in your pharmacy
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Making the Flu Vaccination service work in your pharmacy Martin Littleton Implementation Manager Supporting Community Pharmacy across Avon Outcomes of the Evening Why has the service been commissioned? Outcomes from 2014 What


  1. Making the Flu Vaccination service work in your pharmacy Martin Littleton – Implementation Manager Supporting Community Pharmacy across Avon

  2. Outcomes of the Evening • Why has the service been commissioned? • Outcomes from 2014 • What the service looks like across BNSSG • How to run the service • Self Accreditation – Declaration of Competence • PharmOutcomes • How to maximise uptake of the service – Staff Engagement – How to target the correct patients • Your commitment Supporting Community Pharmacy across Avon

  3. Why Provide a Community Pharmacy NHS Influenza (‘Flu) Service? • Vaccinating people against ‘flu can prevent ill -health and possible death from ‘flu over the winter and reduce hospital admissions • This is true for the whole population, but especially important for the clinical at-risk groups • Primary care is not achieving high enough vaccination rates for clinical at-risk groups Supporting Community Pharmacy across Avon

  4. The National Picture – ‘Flu vaccine uptake rates 2013/14 – 2014/15 Source: Public Health England: ImmForm reporting website: Data submitted by NHS trusts and area teams. Supporting Community Pharmacy across Avon

  5. The South West Picture Uptake rates 2013-14 vs 2014/15 Seasonal flu vaccine uptake in the over 65s across South West CCGs 100 90 80 70 % Uptake 60 50 40 30 2014/15 20 2013/14 10 0 South South North NEW Bristol Somerset Somerset Glouceste Cornwall Devon & England Devon rshire Torbay 2014/15 75.2 76.3 71.3 78.0 70.4 71.6 68.2 72.8 2013/14 75.7 77.1 72.5 79.4 71.3 72.2 69.1 73.2 Target 75 75 75 75 75 75 75 75 75 Supporting Community Pharmacy across Avon

  6. The South West Picture Uptake rates 2013-14 vs 2014/15 Seasonal flu vaccine uptake in the under 65s at clinical risk across South West CCGs 100 90 80 70 % Uptake 60 50 40 2014/15 30 2013/14 20 10 0 North South South Somerse NEW Bristol Somerse Gloucest Cornwall Devon & England t Devon t ershire Torbay 2014/15 51.3 52.7 48.2 56.9 49.4 45.9 45.0 50.3 2013/14 51.1 54.2 51.3 59.6 52.5 49.2 47.6 52.3 Supporting Community Pharmacy across Avon

  7. How can a Pharmacy Service Make a Difference? • Increases the overall vaccination rates, especially in harder to reach groups through: • Better accessibility • Many convenient locations • Long opening hours – open when the patient needs us • Great patient satisfaction • We are already vaccinating people who are eligible for a free NHS flu Jab (via the private service) • ‘At - risk’ groups could attend a pharmacy up to five times within the ‘flu season for a prescription presenting opportunities for vaccination Supporting Community Pharmacy across Avon

  8. Service Performance 2014 • 3,643 vaccination delivered through 162 pharmacies Pharmacies� Pharmacies� Number� of� Average� /� accredited Vaccinated vaccines� Pcy delivered N� Som 23 23 � � � � � � � � � � � � � � � � � � � 392 17.0 S� Glos 28 28 � � � � � � � � � � � � � � � � � � � 660 23.6 Bristol 53 52 � � � � � � � � � � � � � � � � 1,477 27.9 Somerset 61 59 � � � � � � � � � � � � � � � � 1,114 18.3 Total 165 162 � � � � � � � � � � � � � � � � 3,643 22.1 Supporting Community Pharmacy across Avon

  9. Service Performance 2014 Main� Carer� Risk� category?� Chronic� Respiratory� Disease� Diabetes� 4%� 1%� 1%� 2%� Chronic� Liver� Disease� 8%� 9%� Chronic� Heart� Disease� 8%� 1%� Pregnant� Woman� 46%� 20%� Immunosuppressed� Chronic� Renal� Disease� Neurological� condi on� Asplenia� or� dysfunc on� of� the� spleen� Supporting Community Pharmacy across Avon

  10. Service Performance 2014 Was� the� pa ent� vaccinated� in� 2013?� Has� the� pa ent� ever� been� vaccinated� 41%� Yes� for� flu?� No� 59%� 21%� Yes� No� 79%� Supporting Community Pharmacy across Avon

  11. Service Performance 2014 For� pa ents� vaccinated� in� 2014,� were� they� vaccinated� on� 2013?� 1800� 1600� 1400� 1200� 1000� Yes� 800� No� 600� 400� 200� 0� Oct-14� Nov-14� Dec-14� Jan-15� Feb-15� Mar-15� Supporting Community Pharmacy across Avon

  12. Service Performance 2014 More� convenient� Why� choose� pharmacy?� No� GP� Clinic� dates� available� 0%� 1%� 1%� 0%� GP� unable� to� provide� service� 12%� Unable� to� a end� GP� -� work� 5%� commitment� Unable� to� a end� GP� -� other� 13%� commitments� 62%� Prefer� Pharmacy� Unable� to� a end� GP� -� transport� problems� 3%� 3%� Other:� Unwilling� to� say� Unable� to� a end� GP� -� previous� experience� Supporting Community Pharmacy across Avon

  13. What has been Commissioned? • Inclusion criteria for the service • The service will commence in September 2015 and terminate on 31 st March 2016 • Must have consented to vaccination • People aged 65 years or over (including those who will turn 65 by 31 st March 2016) • Patients aged 18 to 64, who must be from one of the following clinical risk groups:- Supporting Community Pharmacy across Avon

  14. Respiratory Disease • Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission • Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; • bronchiectasis • cystic fibrosis, • interstitial lung fibrosis • pneumoconiosis • bronchopulmonary dysplasia (BPD) Supporting Community Pharmacy across Avon

  15. What to look out for: • Anyone with a steroid inhaler • Anticholiergics (tiotropium , ipratropium…) • long acting B 2 agonist • Montelukast • Theophylline • Nebules • Steroids (for breathing.) • For cystic fibrois … Creon capsules ursodeoxycholic acid, antibiotic nebulisers? • Not just Ventolin!!! Supporting Community Pharmacy across Avon

  16. Chronic Heart Disease • Congenital heart disease • Hypertension with cardiac complications • Chronic heart failure • Individuals requiring regular medication and/or follow-up for ischaemic heart disease Supporting Community Pharmacy across Avon

  17. What to look out for: • Congenital Heart disease - Patients with stents, replaced valves, ‘hole in the heart’ – not generally medically treated • Chronic heart failure • Symptoms include dyspnoea, especially during and after exertion (but even at rest if severe), wheeze, cold extremities to name but a few • Treated with combinations of loop diuretics, ACE- inhibitors, β -blocker, spironolactone, digoxin Supporting Community Pharmacy across Avon

  18. What to look out for: • Ischaemic heart disease • AKA coronary heart disease, coronary artery disease • angina medication i.e. regular GTN, nitrates, β -blockers, calcium channel blockers etc. • Complications of hypertension – retinopathy, haemorrhage, kidney problems Supporting Community Pharmacy across Avon

  19. Chronic Kidney Disease • Chronic kidney disease at stage 3, 4 or 5 • Chronic kidney failure • Nephrotic syndrome • Kidney transplantation Supporting Community Pharmacy across Avon

  20. What to look out for: • Drugs including: • Vitamin D analogues including alfacalcidol • Phosphate binders (eg. Calcium, lanthanum, sevelamer, aluminium hydroxide) • High doses of loop diuretics • Immunosuppressants (e.g. ciclosporin, tacrolimus, azathioprine, mycophenolate) • ACE-inhibitors or angiotensin II receptor antagonists are used in nephrotic syndrome to address proteinuria as well as furosemide/spironolactone Supporting Community Pharmacy across Avon

  21. Chronic Liver Disease • Cirrhosis • Biliary atresia • Chronic hepatitis Supporting Community Pharmacy across Avon

  22. What to Look Out For: • Drugs including:- • Colestyramine • High dose ursodeoxycholic acid • Penacillamine • Spironolactone • Loop diuretics • Vitamins i.e. vitamin B, pyridoxine, fat soluble vitamins (A,D,E,K) • Disulfram, acamproste, chlordiazepoxide? • Substance misuse patients? Supporting Community Pharmacy across Avon

  23. Chronic Neurological Disease • Stroke • Transient ischaemic attack (TIA) Supporting Community Pharmacy across Avon

  24. What to Look out For: • Aspirin • Clopidogrel • Dipyridamole • NOT warfarin!!! Supporting Community Pharmacy across Avon

  25. Diabetes • Type 1 diabetes • Type 2 diabetes requiring insulin or oral hypoglycaemic drugs • Diet controlled diabetes Supporting Community Pharmacy across Avon

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