title: Cluster randomised controlled trial of an educational outreach visit to improve influenza and pneumococcal immunisation rates in primary care.
abstract: BACKGROUND
  Improvement in the delivery of influenza and pneumococcal vaccinations to high-risk groups is an important aspect of preventive care for primary healthcare teams.
  
  
  OBJECTIVE
  To investigate the effect of an educational outreach visit to primary healthcare teams on influenza and pneumococcal vaccination uptake in high-risk patients.
  
  
  METHODS
  Cluster randomised controlled trial.
  
  
  METHODS
  Thirty general practices in the Trent region, UK.
  
  
  METHODS
  Fifteen practices were randomised to intervention and 15 to the control group after stratifying for baseline vaccination rate. All intervention practices were offered and received an educational outreach visit to primary healthcare teams, in addition to audit and feedback directed at improving influenza and pneumococcal vaccination rates in high-risk groups. Control practices received audit and feedback alone. All practices measured influenza and pneumococcal vaccination rates in high-risk groups. Primary outcomes were improvements in vaccination rates in patients aged 65 years and over, and patients with coronary heart disease (CHD), diabetes and a history of splenectomy.
  
  
  RESULTS
  Improvements in pneumococcal vaccination rates in the intervention practices were significantly greater compared with controls in patients with CHD, 14.8% versus 6.5% (odds ratio [OR] = 1.23, 95% confidence interval [CI] = 1.13 to 1.34) and diabetes, 15.5% versus 6.8% (OR = 1.18, 95% CI = 1.08 to 1.29) but not splenectomy, 6.5% versus 4.7% (OR = 0.96, 95% CI = 0.65 to 1.42). Improvements for influenza vaccination were also usually greater in intervention practices but did not reach statistical significance. The increases for influenza vaccination in intervention versus control practices were for CHD, 18.1% versus 13.1% (OR = 1.06, 95% CI = 0.99 to 1.12); diabetes, 15.5% versus 12.0% (OR = 1.07, 95% CI = 0.99 to 1.16), splenectomy 16.1% versus 2.9% (OR = 1.22, 95% CI = 0.78 to 1.93); and those over 65 years 20.7% versus 25.4% (OR = 0.99, 95% CI = 0.96 to 1.02).
  
  
  CONCLUSIONS
  Practices where primary care teams received an educational outreach visit demonstrated a significantly greater improvement in uptake in high-risk groups for pneumococcal but not influenza vaccine.
authors.affiliation: Department of Health and Communityu Studies, De Montfort University, Leicester. niro@siriwardena.freeserve.co.uk
authors.forename: A Niroshan
authors.initials: AN
authors.lastname: Siriwardena
authors.forename: Aly
authors.initials: A
authors.lastname: Rashid
authors.forename: Mark R D
authors.initials: MR
authors.lastname: Johnson
authors.forename: Michael E
authors.initials: ME
authors.lastname: Dewey
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000458:organization & administration; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data; D006266:Health Education / Q000458:organization & administration*; D006792:House Calls; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D017589:Immunization Programs / Q000706:statistics & numerical data; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines