Introduction
In Ireland, seasonal influenza vaccination is recommended for persons aged 65 years and older.(1) Influenza vaccination (both vaccine and administration) is free for all medical cardholders and GP visit cardholders in Ireland. This report analyses data obtained from the Primary Care Reimbursement Service (PCRS), HSE-Finance Shared Services, on the number of registered medical and GP visit cardholders aged 65 years and older vaccinated with influenza vaccine (by age group and HSE-Area), at GP clinics and pharmacies for the 2014/2015 influenza season.
The number of patients vaccinated with influenza vaccine detailed in this report refers to GP and pharmacy ‘Paid Claims' for influenza vaccine reimbursement reported by the PCRS, for the period September 2014 to August 2015, inclusive. ‘Paid claims’ refer to claims for payment from GPs/pharmacies for influenza vaccination of patients with medical cards/GP visit cards. These claims have passed validation at PCRS and PCRS will pay/has paid the relevant GPs/pharmacies. Data from pharmacies are only available since the 2012/13 influenza season when administration of influenza vaccine by pharmacists commenced.
Between September and December 2014 the median number of medical or GP card holders among people aged 65 years and older was 458,141 (75.6% of the total population of that age group). The proportion of the population covered varies by age group being lowest in the 65-69 year age group at 50.2%.
Methods
Influenza uptake rates in those aged 65 years and older were calculated based on the proportion of registered patients with medical cards and GP visit cards who were vaccinated during the period September 2014 to August 2015. This period of time was used as it represents the time during which the majority of influenza vaccinations were administered. Definitions of the number vaccinated and the number of patients with medical cards/GP visit cards used in the calculation of influenza vaccine uptake are outlined below:
- The number of patients aged 65 years and older vaccinated with the 2014/2015 influenza vaccine refers to the number of GP and pharmacy paid claims (see table 1 for definitions of claim types) for influenza vaccination reported from the PCRS for the period September 2014 to August 2015, inclusive.
- The median number of registered medical and GP visit cardholders aged 65 years and older were calculated for the period September – December 2014, which is the period of time when the majority of influenza vaccinations were administered.
To assess variations reported by age group and region, uptake was analysed by various age groups (aged 65 years and older) and also by HSE-Area.
Table 1: Type of claim and description of claim type reported from Primary Care Reimbursement Service (PCRS), HSE-Finance Shared Services.
Results
The average influenza vaccine uptake nationally in medical and GP visit card holders aged 65 years and older attending GP clinics and pharmacies for vaccination was 60.2%, during the period September 2014 to August 2015. This uptake rate is an increase compared to that reported for the 2013/14 season (59.4%) and the 2012/13 season (56.9%), however it remains lower than the highest uptake recorded during the 2008/09 season (70.1%) (table 2). Variation in vaccination coverage was observed between age groups, with the highest uptake (65.3%) in those aged 75 years and older and the lowest uptake in those aged 65-69 years (49.8%) (table 3).
Table 2: Percentage seasonal influenza vaccine uptake in Medical Card and GP Visit Card Holders* aged 65 years and older by season (September – August) 2004/5-2014/15, attending GP clinics and pharmacies.
* The number of medical card and GP visit card holders represents the median number of card holders for the period September – December, which is the period of time when the majority of influenza vaccinations were administered.
Table 3: Percentage seasonal influenza vaccine uptake in Medical Card and GP Visit Card Holders by age group (in years) in those aged 65 years and older, attending GP clinics and pharmacies, 2014/15.
* The number of medical card and GP visit card holders represents the median number of card holders for the period September – December, which is the period of time when the majority of influenza vaccinations were administered.
Slight variation in vaccination coverage was also observed between HSE areas, ranging from 55.7% in HSE-NW to 63.7% in HSE-SE (figure 1). In addition, figure 2 shows that HSE-SE has the highest vaccination coverage in all age groups while HSE-NW presents the lowest coverage in all age groups.
Figure 1: Percentage seasonal influenza vaccine uptake in medical and GP visit card holders aged 65 years and older, by HSE-Area for patients attending GPs and pharmacies for influenza vaccination, 2014/15.
Figure 2: Percentage seasonal influenza vaccine uptake in medical and GP visit card holders by age group, by HSE-Area for patients attending GPs and pharmacies for influenza vaccination, 2014/15.
Table 4 includes data on the total number of GP and pharmacy claims by claim type (including data on unpaid claims) for influenza vaccination reported from the PCRS (see table 1 for definitions). Pharmacy claims only accounted for 4.4% (n=12,097) of all paid influenza vaccine claims in those aged 65 years and older for the period September 2014 to August 2015, with GP claims accounting for 95.6% (n=263,846) (table 4). For both GPs and pharmacies, the paid claims were in the majority compared to unpaid claims and vaccine records (97% for GPs and 71.9% for pharmacies) (table 4).
Table 4: Number and percentage of influenza vaccination claims for those aged 65 years and older from GPs and pharmacies reported from PCRS, by claim type, for the period September 2014 to August 2015.
Discussion
The average seasonal vaccine uptake rate (60.2%) among medical cardholders and GP visit cardholders aged 65 years of age and older increased slightly for the 2014/2015 season compared to the previous season 2013/2014 (59.4%). Despite this increase, the uptake is still lower than the recommended vaccine coverage for all EU Member States (75%) and less than the highest uptake recorded during the 2008/2009 season (70.1%).
There are limitations to the dataset analysed in this report. The limitations are primarily based on the eligibility criteria for medical/GP visit cards, for the period of time the report covers (table 1). From mid-2001 to the end of 2008, all individuals aged 70 years and older were eligible for a medical card. Between 2009 and 2015, automatic entitlement to a medical card for those aged 70 years and older no longer applied. During this latter time period all those aged 70 years and older who applied for a medical card were subject to a means test based on income. There were different guidelines for the means test dependent on age, with three age categories: under 66 years, 66-69 years and 70 years and older. GP visit cards have been available since mid-2006 and up to 2015 were also subject to a means test based on income and age. Further information on eligibility for medical/GP cards is available on the Citizens Information Board website. Planned changes to eligibility criteria of medical/GP visit cards for those aged 70 years and older during 2015, do not cover the period of time covered in this report. The proportion of the Irish population with medical cards and GP visit cards aged 65 years and older was 75.6% for the 2014/2015 season.(2)
The next steps of the analysis will include trend analysis of the seasonal influenza vaccine uptake in people 65 years and older and comparison of the uptake among different age groups.
Key points
- Influenza vaccine uptake for those aged 65 years and older during the 2014/2015 season increased to 60.2%, an increase of 1.3% compared to the previous season, however remained below the EU and WHO target of 75% uptake.
- In Ireland, influenza vaccination uptake rates among medical cardholders and GP visit cardholders aged 65 years and older show regional variation with HSE-SE area having the highest uptake rate and HSE-NW the lowest rate.
- Influenza vaccine uptake rates among medical cardholders and GP visit cardholders show age group variation with those aged 75 years and older having the highest uptake and those aged 65-74 years the lowest rate.
- Low influenza vaccine uptake in the 65-69 year age group needs to be addressed. It is important to note that this represents uptake amongst only half of this age group ie those who are eligible for medical or GP visit cards.
- Initiatives need to be developed to promote influenza vaccination uptake among risk groups including those aged 65 years and older as recommended by the European Centre for Disease Prevention and Control (ECDC)
Katerina Chaintarli, Lisa Domegan, Joan O’Donnell, Suzanne Cotter. HPSC
Acknowledgements
The authors would like to thank the Primary Care Reimbursement Service (HSE-Finance Shared Services) for data provided for this study.
Bibliography
- National Immunisation Advisory Committee. Immunisation Guidelines for Ireland. Influenza. Chapter 11. Updated August 2015. Royal College of Physicians of Ireland. http://hse.ie/portal/eng/health/immunisation/hcpinfo/guidelines/immunisationguidelines.html. 2015.
- Domegan L, O’Donnell J, Cotter S, Mereckiene J, O’Flanagan D. Seasonal influenza vaccine uptake in older people improving, but remains below target. Epi-Insight. 2015;16(11).
