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Background Chronic diseases are a major risk factor for influenza morbidity and mortality. However, influenza vaccine coverage in people with chronic diseases remains low, around 43%, in Quebec, Canada. Various strategies are being tested to improve the vaccination rates for this population. A pilot project was implemented in a rheumatology outpatient clinic during the 2018-19 season to improve vaccination access in this often-immunosuppressed group of patients. All patients having an appointment at the clinic during the vaccination period were systematically invited to see the nurse and offered vaccination if they met the program criteria, namely if they were taking immunosuppressive drugs. Methods Implementation and results of the project were evaluated using mixed methods. Data on vaccination were collected from the nurses' forms and from a patient self-administered questionnaire. Data on implementation was collected through the patient questionnaire and semi-directed interviews with the clinic physicians, the clinic nurse and managers. Results A total of 1135 patients were evaluated by the nurses during the project and 427 completed the patient questionnaire. Total vaccination rate amongst patients seen by the nurses was 63%. Based on patient questionnaires results, vaccination was increased by 46%, as compared to the previous year (52% in 2017-18 vs 76% in 2018-19). The project was well received. Key elements of its success were integration in regular clinic activities, support for the initiative by patients and professionals and some logistic aspects such as preloaded syringes. Barriers were mostly related to excess workload and vaccine management. Conclusions Overall, the project improved vaccination coverage and was considered a success. Lessons learned were used to adjust and spread this initiative to more outpatient clinics using personnel dedicated for vaccination rather than using the clinic nurse. A phase II project was done and evaluated in 2019-2020. Key messages Increasing timely access to vaccination helps to increase influenza vaccine coverage. Managers should plan for the increased workload on clinical and clerical personnel when implementing systematic vaccination offer.

Evaluation of a pilot project to increase influenza vaccine coverage in patient with chronic diseases