005B COVID booster recall
The COVID booster recall has become a seasonal event, with different eligibility criteria for Spring and Autumn campaigns. These reports identify patients over the age of 6 months who would be eligible to receive a COVID (booster) vaccination. It forms part of the 005 COVID vaccination programme report category.
Reports
Each COVID booster recall folder has a similar structure, broken down into 4 categories. Cohorts, Recall for COVID boosters, Vaccinated in last 3 months and Data Admin. This structure is seen throughout both the Autumn and Spring folders, but there are slightly different reports depending on the seasonal campaign criteria.
The folder identifying recent vaccinations follows the Green Book recommendations of at least a 3 month interval from the previous dose. We are aware of some materials suggesting a 6 month interval between doses, however setting a rigid 6 month restriction may prevent patients eligible in both Autumn and Spring campaigns from being called on time.
A | Cohorts
As of Spring 2024, the autumn campaign appears to be closely aligned to the seasonal influenza campaign in terms of age and condition eligibility (ie: all over 65s, and 6m-64y clinically at risk); by contrast the spring campaign allows an older age group (over 75) and only those younger patients who are immunocompromised.
These reports are for information and understanding only - do NOT use for recall
Autumn Campaign
There are 3 cohorts which are intended to be unique so a patient cannot appear in more than 1:
Patients living in a care home takes all patients over the age of 16 who are recorded as living in a care home according to the PCN DES care homes coding specification.
Older patients (65 or over) identifies all patients who have had their 65th birthday except those living in a care home. The age cut-off at 65 is a slight misnomer, as like flu it accepts anybody who will have turned 75 by the end of next March.
6m-64 in a clinical risk group identifies all patients in the age range who have a code on their record indicating a clinical risk according to the Green Book. This does not count any codes which have been added to mark the patient as moderate or high risk to a COVID infection.
Spring Campaign
There are 3 cohorts but it is possible for a patient to appear in both the over 75s cohort AND immunosuppressed. Care home patients will only ever appear in the care home cohort.
Patients living in a care home takes all patients over the age of 16 who are recorded as living in a care home according to the PCN DES care homes coding specification.
Older patients (75 or over) identifies all patients who have had their 65th birthday except those living in a care home. The age cut-off at 65 is a slight misnomer, as like flu it accepts anybody who will have turned 75 by the end of next June.
Over 6m who are immunosuppressed identifies all patients over the age of 6 months who have a code on their record suggesting they are immunosuppressed according to the Green Book. This does not count any codes which have been added to mark the patient as moderate or high risk to a COVID infection.
We have also included patients with asplenia or rare inherited anaemia in this search - this represents the row below immunosuppression in Table 3 of the Green Book
At risk conditions
The Green Book maintains separate tables of at-risk conditions for adults (Table 3) and children (Table 4). Best efforts have been made to align searches to the table, although there is a likelihood that some historic coding may pull a patients into the search when a clinician would say they are not eligible.
Immunosuppression
The image below is taken from Table 3 of the Green Book, Chapter 14a.
Patients with conditions that may "require long term immunosuppressive treatment" such as Rheumatoid arthritis and SLE should be checked carefully before invitation. Some of these patients may be managed under secondary care and have hospital issued medication which it not recorded on EMIS (ie: these patients would be eligible), but others may be on the disease register but do not currently take immunosuppressive medication to manage the condition (these patients probably are not eligible).
There are no codes to exclude a patient from the recall search.
B | Recall
These searches should be used as the basis of a recall. They are built to only include eligible patients in the cohort, but exclude anybody who has been vaccinated in the last 6 months (see next section).
The searches have been designed to take advantage of EMIS' relative run date feature. Practices may notice a significant difference to the search results depending on the date they use to run the search. This is because the recall searches do not include any patients who has received a vaccination in the past 3 months. When running the folder for Autumn recall, use a relative run date of the same day as a planned clinic. The reason for this is that any patients who received a dose in June/July may be excluded if it falls just within the Green Book's minimum 3 month interval between doses.
Please read the section "Immunosuppression" above before issuing any invitations to patients in the 'at risk' search.
Autumn recall of immunocompromised patients
It is intended that practices work down these searches.
Primary Care IT strongly recommends that this search is reviewed carefully prior to any invitations being issued. The reports for adults and children have been built to show the codes or medications that are likely to make a patient eligible for a vaccine.
Below are some of the issues to look out for
- For many conditions that also appear as a QOF register the presence of a code will be more important than a date.
- Entries in 'Asthma systemic corticosteroid issues in last 24m' and 'Asthma admissions in last 24m' will only show if there is an actively managed asthma patient.
- The count of issues in 'Asthma systemic corticosteroid issues...' should also be considered in the context of co-morbidities. While a figure will only show if the patient has asthma, a co-morbidity requiring steroid management may cause the number to be higher than the count of issues intended for complications of asthma.
- Immunosuppressing treatment and medication requires careful review. Hospital issues will be shown where recorded.
- Patients appearing with a date and code in the 'Currently pregnant' column may have given birth
Given the expected size of these reports, exporting to view in Excel may be a far more effective approach to sorting and reviewing the cohort.
If a patient has a completely empty row, the original coded reason for their inclusion can be found using Check Patient on the searches CVP-06 COVID at-risk groups for adults or CVP-07 COVID at-risk groups for under 16 in the Data Admin folder.
Spring recall of immunocompromised patients
The Spring booster campaign includes patients aged 6 months to 74 years who are immunocompromised. A limitation of reference sets used is that some codes do not qualify for a vaccination. In v2.1 the cohort was separated into those who could be invited straightaway (search c), and those who should be checked by a clinician (search d) prior to invitation.
Use the report d) Immunosuppressed patients requiring REVIEW prior to invite to check whether patients are eligible. The report output includes any patient with Coeliac disease, asplenia or splenic dysfunction, or hereditary haematological conditions. The majority of patients included are likely to have Coeliac disease and are therefore not eligible UNLESS they have another qualifying immunosuppressing condition or medication.
Almost all patients should have an entry in one of the first 2 columns (headed REVIEW). Subsequent columns represent other conditions which may have occurred many years ago, or may be recent. Inclusion in any subsequent column other than Steroid issues is likely to indicate eligibility.
Patients who have been confirmed as eligible from this search would need to be invited manually. Ensure that invitation coding is consistent with any action taken for patients in search c.
C | Vaccinated in last 3 months
Patients who have a record of a coded vaccination in the last 3 months are separated by cohort. The final report may be regarded as a catch-all, but it will also capture any patients falling outside of the 3 cohorts who have received a vaccination. This may be a first, second, or successive booster dose as all vaccination codes are being picked up.
The reports look at a rolling 3 months so they are only ever likely to be accurate for the day they are run. Remember using a relative run date in the future will effectively shorten the duration from the present.
D | Data Admin
COVID vaccination declined in last 6 months Lists all those who have declined recently, to allow them to be removed from any report. Practices may wish to extend the declined period to 12 months or even longer if they do not want to include dissenting patients on their recall lists. If the search folder is updated by PCIT, these changes will be removed.
COVID vaccination invitation in last 3 months Counts all patients who have been invited, as long as an invitation code has been added to the record. If no invitation code has been used, the recall reports will only reduce if/when a vaccination is recorded.
COVID at risk groups takes the clinical risk groups listed on Table 3 (adults) and Table 4 (under 16s) of Green Book Chapter 14a. Many Practices will find that the results broadly correspond to the flu at-risk groups, although some additional patients are likely to be picked up. The search contains QOF code clusters, COVID19 specific code clusters, and other clusters which reflect the conditions described in Tables 3 or 4. The 6m-64 cohort is age appropriate according to the table.
Most of the conditions listed in Table 3 but not in Table 4 are very unlikely to be found in children, and there are also some additional conditions in Table 4 not specified in Table 3.
Patients contraindicated for COVID vaccine identifies patients who have been coded with specific terms released since COVID-19. Any of these would have been done following a clinical review, so the numbers are expected to be very small. Periodically check these patients in case the contraindication was recorded early on in the pandemic in anticipation of a particular type of vaccine.
Coding
It should be noted that the relevant searches built by PCIT contain all codes and not just those which are specified to ensure that all patients are captured correctly in case the wrong code was used on a record.
COVID vaccination declined
SARS-CoV-2 vaccination declined [1156270003] (and all children)
SARS-CoV-2 immunisation course declined [1324811000000107]
SARS-CoV-2 protection maintenance course declined [1362651000000105]
COVID vaccination invitation
SARS-CoV-2 vaccination invitation letter [1402921000000102] (and all children)
SARS-CoV-2 vaccination telephone invitation [1402931000000100] (and all children)
SARS-CoV-2 vaccination invitation email [1403101000000104] (and all children)
SARS-CoV-2 vaccination invitation SMS [1403031000000106] (and all children)
COVID vaccination
Administration of SARS-CoV-2 vaccine [1156257007] (and all children)
SARS-CoV-2 protection maintenance course started [1362681000000104]
SARS-CoV-2 protection maintenance course started [1362691000000102]
Immunisation course to maintain protection against SARS-CoV-2 [1362591000000103]
Combining with flu
Some Practices may wish to combine eligible patients for both flu and COVID vaccinations. As has been stated, the vast majority of patients eligible for COVID will already be eligible for flu. There is a key difference between Primary Care IT's at-risk cohort for COVID and the at-risk cohort for seasonal influenza; seasonal influenza uses the exact business rules for the Enhanced Service meaning every code will count, while COVID is an interpretation of a table of text. Every effort has been made to utilise the same code groups were possible, and elsewhere we have worked to find the most appropriate code clusters for the conditions listed in the Green Book.
If you wish to combine the two groups into a single search, we suggest building a Joint Report like the below screenshot. Patients aged 6m-17y will not be included.
To find patients who only appear in the COVID searches, change the join type to ignore report 1 (assuming that is flu recall)
Think about other elements you can bring into a search to avoid inviting patients who are already booked in by excluding future appointments using a certain slot type.
References
Green Book Chapter 14a (26 April 2023 version), (18 April 2024 version)
Support Information
Development Log
09/10/2024 - Updated at risk cohort with additional conditions.
Communications Log
π Announcing the COVID Vaccine Autumn Campaign Searches! ππ
Exciting news for healthcare providers! Our searches are designed to streamline the COVID vaccine booster campaign and enhance patient care. π©Ίπͺ
Key Features:
π Easy Patient Identification: Quickly locate eligible patients for the autumn booster campaign
π Vaccine Coverage Tracking: Monitor vaccine coverage rates within your patient population
π Data Quality Checks: Identify and rectify data errors effortlessly
The COVID Vaccine Autumn Campaign Searches simplify the vaccination process, ensuring eligible patients receive timely reminders and care. It's available now and integrated seamlessly into EMIS Web and SystmOne. π₯π
Join us in making the COVID vaccine campaign efficient and effective. Let's ensure that every eligible patient receives the protection they need! ππ
#COVIDVaccine #BoosterCampaign #HealthcareProviders #DataAccuracy #PatientCare #IntegratedTools
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