RESEARCH THEMES
RAPID IMPLEMENTATION
The objectives of the Rapid Implementation of Vaccine Programs theme are to:
- Create a network of experts, decision-makers, and operational/clinical professionals responsible for mass vaccination clinics;
- Develop methods to consistently measure efficiency and effectiveness of methods of delivering vaccines in a mass clinic setting;
- Explore and evaluate novel, safe, and effective methods of delivering vaccine in mass clinic settings.
CURRENT PROJECTS (2011-2012)
The Operational Effects of Implementing Live, Attenuated Influenza Vaccine (LAIV; FluMist® AstraZeneca) in a Mass Immunization Clinic
In 2010, an intranasal, live, attenuated, trivalent vaccine (FluMist® AstraZeneca) was licensed in Canada for use in people aged 2 to 59 years. Controlled clinical studies have demonstrated LAIV is effective in preventing influenza illness in children, and LAIV formulations are at least equally effective, if not more effective, in preventing influenza culture confirmed infection as the usual injectable formulations. Additionally, it has been demonstrated that the administration of LAIV product is well received by children and caregivers in clinical trials. Despite these benefits, determining the full cost of deployment for this vaccine formulation is important prior to wide-spread use in immunization clinics. Operational concerns include time to deliver the vaccine, requirement for extra training of staff, extra clinic space requirements, and vaccine storage requirements. Working with various immunization clinics in Alberta, time-motion, focus group, and client survey data will be collected to examine the operational impacts of delivering FluMist® in mass immunization clinics.
Influenza Immunization in School Located Clinics
Despite being offered often without charge, influenza vaccine uptake has remained disappointingly low in some areas of Canada. For example, some areas of Alberta had only 35% uptake in 2009-2010 and 22% in 2010-11 (pers. comm. AHS CDC Surveillance). Of particular concern is the low uptake by children 24 months to 9 years of age and the fact that individuals between 9 to 64 years had only 16% uptake. Additionally, the highest rate of confirmed influenza illness in southern Alberta between August 29, 2010 and June 4, 2011 was in the pediatric (0 to < 9 years) population (pers. comm. AHS CDC Surveillance). The location of immunization clinics may improve or negatively impact vaccine uptake by members of the public as some locations are more convenient for certain population segments. For example, family groups may attend clinics at school buildings because they usually drop off their children at these locations daily, allowing adults and preschool children to be immunized at these convenient locations as well. Working closely with Alberta Health Services and administrators of various schools in southern Alberta, RIVP will examine the impact of location on vaccine uptake as well as flu-related absenteeism at schools with immunization clinics relative to those without a clinic.
Improving Throughput at Immunization Clinics: Evaluating Electronic Delivery of Consent Information, Part II
During the 2010-2011 influenza season, PCIRN researchers piloted a novel consent information- sharing process in influenza clinics (see “Improving Throughput at Immunization Clinics: Evaluating an Alternate Method of Conveying Consent Information, Part I” below). This process entailed delivering risk/benefit and after-care information to individuals or groups prior to reaching immunization stations. An evaluation of this information-sharing process revealed that the content retention of consent information was at least equivalent to the one-on-one information-sharing process usually implemented within clinics.
These findings provide support for exploring other avenues of disseminating information shared during the consent process via a new ‘mobile friendly’ Alberta Health Services Influenza website. This site, accessible via mobile phone, contains risk-benefit information provided in a YouTube video as well as additional information about the annual influenza vaccine and its local availability. To evaluate the efficacy of accessing vaccine information via this mobile website, online and paper-based client surveys will be used to quantify the success of providing information using the website. This project is being developed in concert with the launch of a new Alberta Health Services website as well as beta-testing of a mobile application for use by members of the public.
YEAR 2 PROJECTS (2010-2011)
Operational Challenges in Vaccine Delivery during the 2009 pH1N1 Pandemic: a Pan-Canadian Survey
The RIVP group was challenged to develop and deliver a Pan-Canadian Survey in the spring and summer of 2010, measuring provincial and territorial operational challenges in vaccine delivery in the pandemic year of 2009. The group worked with the Canadian Immunization Committee to develop content and questions. The survey involved in-depth interviews with key informants across every province and territory except for PEI. Results are currently being analyzed, and preliminary findings were presented at the Canadian Immunization Conference in December 2010.
Rapid Influenza Vaccination using a Communal Services Model in First Nations Communities
Building on existing relationships between Alberta Health Services and First Nations communities, RIVP has engaged a First Nations community in Alberta to partner in observational research of immunization services provided in the group’s territory. The objective of this project was to examine the potential difference in throughput (i.e., vaccine deployment) using a communal services clinic model in First Nations communities vs. using a single service clinic model. For example, in a communal services setting, various health services are provided or offered to clients, such as diabetes screening, while a single service model involves only offering the influenza vaccination service.
Rapid Deployment of Influenza Vaccine in Western Canada
At four participating clinics in Alberta and three clinics in Saskatchewan, client demographics, clinic characteristics, and client and staff satisfaction were assessed to examine processes impacting vaccine deployment in the year following the pH1N1 pandemic (2010). Particular attention was paid to client perception, comprehension, and retention of information given in the consent process at the clinic.
Improving Throughput at Immunization Clinics: Evaluating an Alternate Method of Conveying Consent Information, Part I
In Alberta, immunizers are required to obtain informed consent before administering a vaccination. Generally, registered nurses meet individually with clients at a vaccination station to share information about influenza, expected benefits of treatment, material risks, potential adverse effects, and after-care measures. This form of information transfer can take considerable immunizer time as the same generic information is delivered to each client. RIVP Year 1 (2009-2010) findings suggested that, in a pandemic, the consent process could slow the rate at which clients are immunized. Hence, in Year 2 (2010-2011) a novel method of providing patients with consent information was tested to ensure that it saves immunizer time as well as allows clients to easily understand the risk/benefit information provided. Clients were provided with a brief presentation of risk-benefit information prior to reaching vaccination stations, at which time the immunizer would confirm informed consent and administer the vaccine. Results indicate that this alternate consent process did not negatively affect information learning by clinic participants and that comprehension and retention of shared information is just as good under an alternate consent condition as when individuals get this information from nurses one-on-one. However, time-motion analyses indicate that, individually, clients took longer to be vaccinated when using the alternate consent method.
YEAR 1 PROJECTS (2009-2010)
The Impact of pH1N1 on Rapid Deployment of Influenza Vaccine in Western Canada
A mixed-methodology approach was designed for evaluation of pH1N1 clinics in the winter of 2009. Data were obtained in vaccine clinics located in urban, rural, and hard-to-reach areas in Alberta. The data collection comprised methods from the quantitative (a clinic audit tool, time-and-motion analysis, and a patient/client survey) and qualitative realms (observational ethnography and staff focus groups). This design evaluates the physical site, clinic processes, and staff factors required for operations. While client surveys revealed a generally positive experience by respondents at clinics, staff focus groups identified issues with changing priority groups during the progression of the flu pandemic. In particular, there was disconnect between health organizations determining the criteria, the public, and immunization clinics with either the public or the clinic not receiving up-to-date information about changes in a timely manner. This resulted in clients being refused the vaccine during their initial or subsequent visits because they were not part of the target priority group.
Marcia M. Johnson MD, MHSc, FRCPC
Principal Investigator
Dr. Marcia Johnson is the Acting Medical Officer of Health, Alberta Health Services - Edmonton Zone. She received a MD from U of Saskatchewan and worked as both a family practitioner and emergency room physician in Vancouver, BC. She obtained a Masters in Health Sciences at UBC in 1990 and completed her Community Medicine Residency in 1993. Dr. Johnson gained international experience in the King Faisal Hospital & Research Centre in Saudi Arabia and at the International Hospital in Beijing, China before accepting her current position with Alberta Health Services. Dr. Johnson's current responsibilities include regional oversight for Communicable Disease Control (CDC), Environmental Health and Population Health in the Edmonton Zone. She is an adjunct professor in the Department of Public Health Sciences, University of Alberta.
