Influenza and pneumococcal vaccinations in dialysis patients in a London district general hospital

BACKGROUND: Patients on dialysis mount reduced immune responses compared with the general population. The Department of Health advises that these patients receive influenza and pneumococcal vaccinations at regular intervals—once yearly and every five years, respectively. This article investigates the uptake of these vaccinations in this patient population and seeks to examine factors that may influence vaccination status such as patient's language and presence of a general practitioner (GP) electronic vaccination reminder system. It also explores preferred site of vaccination for patients and GPs as these are primary care vaccinations yet patients have more frequent contact with their dialysis unit than their GP, blurring the boundaries between primary and specialized care. METHODS: This is a retrospective study of all patients registered as dialysing at the North Middlesex University Hospital NHS Trust (NMUH) in September 2011. Information was obtained through GP letters, GP and patient questionnaires. RESULTS: Of 154 patients, 133 were included in the data analysis. Nineteen per cent were up-to-date with both vaccinations and 67% with their influenza vaccination. Fifty per cent had received the influenza vaccination in the last two consecutive years. Thirty per cent were not up-to-date with either vaccination. There was no evidence of a difference in uptake in 2009 (P = 0.7564) and in 2010 (P = 0.7435) among those who could and could not speak English. Twenty-five per cent of GPs and 58.6% of patients preferred vaccination to occur in the dialysis unit. Unfortunately a high number of GPs did not provide information on whether they used an electronic vaccination reminder but the analysis from the information provided by the few respondents did not reveal any correlation between the presence of an electronic reminder and vaccination status. CONCLUSION: Most dialysis patients were not up-to-date with both vaccinations. They were, however, more up-to-date with their influenza than their pneumococcal vaccination. Non-English speakers did not appear to be disadvantaged. GP electronic reminder systems may have influenced influenza uptake but this study did not demonstrate a correlation and this is likely due to the lack of GP respondents; the effectiveness of electronic reminders merits further studies as a tool to improve vaccination rates in at-risk populations. Most patients visited their GP at least annually but preferred to receive their vaccinations at the hospital. Vaccinating in the dialysis unit and maintaining an electronic record accessible to GPs or generating a letter for GPs may help fill the vaccination gap in these patients. Overall, more evidence is required for the effectiveness of such vaccinations and their frequency, but in the meantime UK national guidelines were not being followed with a large proportion of patients remaining unvaccinated against influenza and in particular pneumococcal disease. This audit highlights the importance of local data collection, discussions around correlations influencing outcomes and publication of results to improve standards of care at a national level.