Provider Intervention Leads to Increased Flu Vaccination Rates Among Patients With COPD

Physician and nurse interventions are the most effective means of promoting influenza vaccinations among patients with chronic obstructive pulmonary disease (COPD), according to the results of a pilot project.

Physician and nurse interventions are the most effective means of promoting influenza vaccinations among patients with chronic obstructive pulmonary disease (COPD), according to the results of a pilot project.

The project, conducted at the National University Hospital in Singapore, is the largest prospective study of its kind aimed at increasing vaccination rates in patients with COPD, the authors said.

Of the 348 patients included in the project, researchers found the initial baseline vaccination rate to be 47.7%, while the final rate was significantly higher at 80.7%. In addition, “63 patients refused vaccination pre-intervention, but this number reduced to 22 patients post-intervention.”

Regular influenza vaccinations have been shown to reduce COPD exacerbations, which are one of the leading causes of hospitalizations around the globe. These exacerbations result in an accelerated decline in lung function, lower quality of life among patients, and mortality rates as high as 20%.

In the United States, vaccination rates among people with COPD range between 20% and 60%.

Viral infections account for the majority of infective exacerbations and tend to be more detrimental to a patient’s health. The influenza virus, rhinovirus, and respiratory syncytial virus are the most common viral infections among patients with COPD.

“In Singapore, more than 88% of the patients with COPD did not receive their influenza vaccination within the last year,” said the authors. To lower this number and decrease rates of infective exacerbations, researchers collected data from one of Singapore’s tertiary referral hospitals. Patients with COPD were enrolled in an “integrated nurse-led, specialist-supported” program called TAP. The program started in 2013 and researchers followed up with patients in 2015.

The project consisted of physicians and nurses utilizing strategic tactics to boost immunization rates. Some physicians interacted directly with patients, explaining the importance of immunizations, while nurses often followed-up with patients who neglected to get their vaccinations.

A new electronic healthcare record system (EHR) was also implemented and facilitated the easy retrieval of patient records and immunization history.

Patients and providers completed surveys and questionnaires distributed at the time of vaccination to determine which intervention methods were the most successful.

Physician intervention accounted for 87.9% of the increase in vaccinations while the remaining increase is due to nurses’ reminders. The personal connections providers established with their patients aided in convincing those with COPD to get immunized.

Doctors reported that being informed of the extremely low vaccination rate among patients with COPD was the driving factor behind physician intervention.

“Physicians’ vaccination prescription practices changed as a result of self-awareness of low vaccination rates, vaccination card reminders, and the new EHR,” researchers said. In addition, efforts to improve patient education on the topic had minimal to no impact.

Although the results are promising, researchers point out local settings contribute to the findings. Influenza vaccination awareness is low in Singapore to begin with and researchers said patients with COPD also tended to be older and had poor health literacy. They also note a Hawthorne effect may have contributed to the results, meaning that because doctors knew patients’ vaccination rates would be monitored during the study, physicians consciously made an effort to address the issue.


Li A, Chan YH, Liew MF, Pandey R, Phua J. Improving influenza vaccination coverage among patients with COPD: A pilot project. Int J Chron Obstruct Pulmon Dis. 2019;14:2527-2533. doi: 10.2147/COPD.S222524.

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