Partnerships, Drive-Throughs Seek to Increase Veterans’ Flu Immunization

by U.S. Medicine

December 9, 2014

Free Shots Available at Walgreen’s Locations

By Annette M. Boyle

SAN FRANCISCO – The VA typically has influenza vaccination rates well above the national average but is trying some innovative measures to do even better.

As part of the effort to increase immunizations, particularly among higher-risk veterans, the agency recently announced a national partnership with Walgreens to enable veterans to receive a flu shot at any of the chain’s retail pharmacies.

“Historically, our outpatient sampling rates have been about 10% higher in the age 65-and-older bracket and about 20% higher in the 50-to 64-age group. Nevertheless, from population and public health perspectives, there are always gaps to close and disparities to address when trying to increase flu vaccine uptake,” said Troy Knighton, EdS, MEd , LPC, the VA’s national seasonal influenza program manager.

Overall, more than 70% of veterans receive influenza immunizations each year, but the VA wants to increase the rate to more than 90% among high-risk individuals, said Douglas Trauner, first entrepreneur in residence at the VA Center for Innovation.

As part of the effort to increase immunizations, the VA recently announced a national partnership with Walgreens to enable veteran patients to receive a flu shot at any of the chain’s retail pharmacies for free.

As part of the effort to increase immunizations, the VA recently announced a national partnership with Walgreens to enable veteran patients to receive a flu shot at any of the chain’s retail pharmacies for free.

The new program will cover up to 75,000 flu shots.

“I think it will improve the uptake of flu vaccine, especially among enrolled veterans who don’t live near a VA healthcare facility,” Knighton said, adding that that should “reduce flu illness and deaths, especially in our elderly populations.”

To receive the shot for free, veterans only need to tell the pharmacist that they receive care at a VA medical facility and show their VA identification card. Walgreens will administer the vaccine, then transmit the immunization record to the veteran’s VA health record.

For the Walgreens pharmacist, the VA program requires no change in the workflow for immunizations. “Pharmacists just take information from the VA card rather than from an insurance card,” explained Walgreens spokesperson Markeisha Marshall.

The information then goes to the chain’s “cloud EHR that allows us to talk to each of our pharmacies and with partners who allow us to share records through ehealth exchange, so patients have a complete electronic health record,” Marshall added.

That last step has the potential to significantly boost known immunization rates among veterans.

“We know many veterans were getting their shots outside the VA system, particularly if they had commercial insurance or had Medicare part B, which gave them no-cost flu shots in retail settings,” Trauner told U.S. Medicine. The VA did not know, however, exactly how many or which veterans received immunizations at their community pharmacies.

“The absence of retail pharmacy immunization data means you are flying blind,” Trauner said, both for the particular veteran’s health record and for overall population health data. With the Walgreens partnership, which was piloted in Florida during the last flu season, the health information comes back to the VA and “shows up in the VA record just as if it were given in a VA facility. It’s a good first-use case for how we can get information about purchased care integrated into the VA workflow so we can manage care more effectively,” he noted.

The VA plans to expand the program to other national pharmacy chains next year. “This program allows us to leverage the power of connected health records and national partners through a single point of integration. It’s a compelling story for the VA for immunization and other applications,” Trauner said.

The partnership tests outsourcing of care and collaboration as part of an effort to find the “specific use cases where this can work really well,” he said. “The driver here is: How do we deliver better care? Period.”

The retail pharmacy program is not the only innovation in flu vaccine delivery. Knighton noted that many facilities have continue to conduct “drive-through” flu clinics this year to enable veterans and VA staff to receive vaccination without leaving their cars. At other facilities, “chiefs of staff and facility directors walk around with the ‘flu cart’ offering flu vaccines floor to floor. They work beside the flu teams to personally demonstrate their commitment and dedication to keeping staff and patients healthy through flu vaccination,” he added.

Last year, the Boston VA Medical Center created a “Flu Fighters” campaign that addressed education, accessibility, communication and data management to significantly increase their vaccination rates. “Their Facebook ‘Town Meeting’ was most impressive and demonstrated a new and effective way to reach veteran audiences,” Knighton noted.

Flu Vaccines Offer Broader Protection

A new study also has found that seasonal flu vaccines may protect individuals not only against the strains of flu they contain but also against many additional types. The study, published this month in mBio®, the online open-access journal of the American Society for Microbiology, found that some study participants who reported receiving flu vaccines had a strong immune response not only against the seasonal H3N2 flu strain from 2010, when blood samples were collected for analysis, but also against flu subtypes never included in any vaccine formulation.2

The finding is exciting “because it suggests that the seasonal flu vaccine boosts antibody responses and may provide some measure of protection against a new pandemic strain that could emerge from the avian population,” said senior study author Paul G. Thomas, PhD, an Associate Member in the Department of Immunology at St. Jude Children’s Research Hospital in Memphis, TN. “There might be a broader extent of reactions than we expected in the normal human population to some of these rare viral variants.”

Because avian influenza viruses have an important role in emerging infections, Thomas and colleagues tested whether exposure to different types of birds can elicit immune responses to avian influenza viruses in humans. They studied blood samples taken from 95 bird scientists attending the 2010 annual meeting of the American Ornithologist Union.

In the tests, 77% of participants had detectable antibodies against avian influenza proteins. Most individuals tested had a strong antibody response to the seasonal H3N2 human virus-derived H3 subtype, part of that year’s vaccine (2009-2010), but many also had strong measurable antibody responses to group 1 HA (avian H5, H6, H8, H12) and group 2 HA (avian H4, human H7) subtypes. Sixty-six percent of participants had some level of detectable antibodies against four or more HA proteins, and a few had responses to all subtypes tested, most of which have not previously been detected in the human population.

Thomas noted that the work has raised questions about why people mount different types of responses, and potentially how the seasonal vaccine may play a role in boosting these responses. He added that ed additional studies in subjects with varied vaccination and infection histories  are ongoing to try to determine what exposures boost immunity against avian influenza viruses.

1 Grohskopf LA, Shay DK, Shimabukuro TT, Sokolow LZ, Keitel WA, Bresee JS, Cox NJ. Prevention and Control of Seasonal Influenza with Vaccines: Recommendation of the Advisory Committee on Immunization Practices—United States, 2013-2014. MMWR. September 20, 2013/62(RR07);1-43.



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