Closing the Gap on Immunization Disparities Among Seniors Living in Chicago Public Housing

Background:  Over the last decade, on average 3,500 individuals in Illinois die from influenza and pneumonia each year, with the majority of those deaths occurring in individuals 65 years and older. A Special Innovation Project (SIP) that was previously conducted by the QIN-QIO, identified Chicago communities with significant minority populations, who are of low socio-economic status (SES) and experience disproportionately high levels of violence. Barriers to preventive healthcare services including immunizations were identified and included: personal safety concerns, lack of physical access and mobility, cost of vaccinations and negative beliefs regarding vaccinations.

Program background:  Telligen, the Illinois QIN-QIO, partnered with the Chicago Housing Authority (CHA), Blue Cross Blue Shield of Illinois (BCBSIL), EverThrive Illinois, Chicago Department of Public Health and Walgreens in a collaborative effort to increase the influenza and pneumococcal vaccination rates for 10,000 seniors and dual eligible individuals living in CHA housing. The QIN-QIO developed educational materials and provided strategic planning as well as logistical coordination. This community-based intervention aimed to increase influenza and pneumococcal vaccination rates in a targeted “hard-to-reach” vulnerable population – seniors living in 39 CHA housing. QIN-QIO facilitators led an educational session at each senior CHA facility. Education sessions included information about the influenza and pneumococcal vaccinations, myths, facts and recommendations. Due to the recent introduction of Prevnar 13, the administration and timing of the vaccination was given particular importance. Sessions were interactive with opportunities for the seniors to ask questions, voice concerns and clarify misunderstandings. Educational brochures provided to residents regarding the influenza, pneumococcal and herpes zoster were made available in multiple languages. Posters and reminder slips in multiple languages were also distributed at each housing site. A week following the education session at the CHA senior buildings, the BCBSIL immunization van was brought to the building to provide on-site influenza and pneumococcal vaccinations. Vaccinations were provided by a Walgreens pharmacist at no out-of-pocket cost to the seniors. Additional influenza vouchers were made available for uninsured residents.

Evaluation Methods and Results:  Information from the 2015-2016 influenza season will be the baseline for the Flu Fighters! initiative. In total, over 800 influenza and pneumonia vaccinations were provided at 39 CHA sites. Data was gathered at each site and put into a tracking tool which will allow for future comparisons. A Plan, Do, Study, Act (PDSA) cycle was performed during the initiative to identify which communication method best led to increased turnout for the immunization van. This PDSA was used to identify the most efficient communication tool for use in future initiative years.

Conclusions:  The Flu Fighters! initiative demonstrated that the use of a community-based collective approach can reduce barriers to preventative healthcare services and allow under-served populations better access to important vaccinations.

Implications for research and/or practice:  By engaging patients in their own healthcare through a community-based approach, the Flu Fighters! were able to provide needed preventative services to a hard-to-reach communities that otherwise could potentially continue to be ignored. Planning for the 2016-2017 flu season will begin in April 2016.