034B Eligible for shingles vaccination searches
This folder (v2.4) now sits within 034 Eligibility. It was previously found in 020 Practice Administration.
The shingles eligibility searches were completely re-written to account for the changes to the vaccination programme from September 2023. These searches are provided to help Practices call and recall patients based on the new criteria. A separate folder of CQRS searches is provided to ensure coding is correct for receiving full payment. Practices should manage their recalls and stock ordering in line with guidelines; whilst Zostavax remains available, it will remain the primary vaccination for most patients eligible before 1st September 2023, but these will not necessarily be picked up in the invitation searches provided.
Primary Care IT strongly recommends that this article is understood before the searches are used in your Practice.
Searches in the top level folder are designed to support Practices regularly inviting patients for a shingles vaccination. All searches have been built with the ability to be run on different dates using the Relative Run Date function. This may be helpful for Practices who have not run a recall for several months, and need to invite patients for the first time who turned 70 before 1st September 2023.
Cohorts for shingles vaccination
This folder contains 4 searches representing the cohorts who are eligible to receive a flu vaccination according to the Green Book and Enhanced Service specification in September 2023. There are no exclusions in this folder for patients declining or vaccinations given, so they should not be used for call/recall purposes
- Age 70-79 : those patients in their 70s (ie: they have had their 70th birthday, but have not yet had their 80th birthday)
- Age 65 catch-up : patients born after 01/09/1958 who have had their 65th birthday but not their 70th birthday. This cohort will begin to increase in size from 1st September. Assuming no further changes to the eligible criteria, patients will begin to move from this cohort to the 70-79 cohort in September 2028.
- Age over 50 and immunocompromised : patients aged between 50 and 81* who have a code on their record indicating they are immunocompromised. These codes are defined by the Shingles Vaccination Enhanced Service.
A number of child searches are provided to separate out the different immunosuppressive eligibility criteria. Patients in the parent search will appear in one or more of these child searches. All of the same information can be viewed using the report PA-348) Immunocompromised for shingles vaccination. - Requires shingles vaccination : patients aged between 50 and 81* who are otherwise not eligible who have been clinically reviewed and given a code indicating they require a shingles vaccination (much like equivalent codes for flu and pneumococcal vaccinations). This search includes both the valid code and the invalid EMIS code.
* 80 year olds are included in this cohort to support the invitation for 2nd dose.
A 5th search exists for information only which combines all patients eligible - according to CQRS - who have not yet received a vaccination. We do not recommend using this search to invite patients. Patients who have previously declined are still technically eligible but are not included - reference the declined search in Data Admin for these patients.
Patients who have been previously invited (in their 70s) but have not accepted the offer of a vaccine remain eligible although there is no requirement for Practices to send a second invitation. If a second invitation is desired, a child search could be added which looks at patients of a certain age - keep the age range relatively small to manage supply and demand.PCIT has decided to keep the age cohorts separate from the immunocompromised cohorts. This does unfortunately mean that patients may appear twice in certain searches. Remember that the immunocompromised and requires shingles vaccination cohorts have a shorter minimum interval for receiving a second dose.
Eligible for shingles vaccination
This section describes searches found in the top level folder.
Patients who can be sent an invitation for shingles vaccine now
All patients who can be sent a first ever invitation for a shingles vaccination due to:
- age (70-79, 65 year olds)
- being ready to receive a second dose immediately
- about to have their 80th birthday with no previous record of vaccination
This search can be used to generate a list of patients for invitation. Some Practices may prefer to use the searches in the Targeted recall folder to customise the invitations.
Be aware when using this search that some patients may be reported as ineligible when checking HP048 Eligible for shingles vaccination. Some patients are turning 65 or 70 within the next month, with an expectation that they have had their birthday by the time they have received the letter, contacted the surgery to book an appointment, and then waited a period of time until the appointment date.
Invite for SHINGRIX 2nd dose now
Depending on the qualifying criteria, patients appear in this search either 8 weeks after receiving their 1st dose, or 6 months. This allows Practices to recall patients to receive a 2nd dose within the optimal timeframe. An exclusion criteria has been built in to ignore patients who have been invited in the previous 8 weeks or 6 months (which would have been after their 1st dose.
If patients do not respond to a coded recall they will continue to appear in this search, in a frequency which will be exaggerated for those immunocompromised patients who would appear every 8 weeks. If Practices feel that this frequency is too much, it would be possible to amend the 'Exclude' feature in each rule to a longer timeframe.
Immunocompromised for shingles invitation?
In Autumn 2023 this search is likely to be relatively large as all patients become eligible on 1st September 2023. Practices may want to stratify the calling process to manage supply and demand. If patients are invited and coded with an invitation, they will not appear for another 5 years as long as they haven't declined in the intervening period. Therefore re-running this search after inviting a batch of patients will automatically correct the list of patients who are yet to be invited.
The criteria for these searches utilise the business rules and codes found in the Enhanced Service. The Green Book specifies severe immunocompromising conditions as well as some lower daily dose limits for certain drugs (eg: DMARDs) which are not factored into the searches. Practices may wish to take a view on such patients whose vaccinations would be paid by CQRS, but are not eligible by the letter of the Green Book. Practices should therefore exercise some caution and review patients in this group prior to invitation.
It is strongly recommended that the report attached to this search is used for clinical review before any invitations are issued. We suggest incorporating the following process into your invitation programme to ensure the correct patients are invited and can be captured by CQRS for payment.
- Run the report Immunocompromised for shingles invitation?
- Arrange for a clinician to review the report. This may be done by exporting the results to Excel, viewing on screen, or printing (although the size of the report is likely to make a printout difficult to read)
- The clinician should review each patient with the Green Book criteria in mind. They should review every patient irrespective of age. The report extracts the reasons for inclusion in the search which may be numerous.
- When a patient has been reviewed and confirmed that they should be eligible to receive SHINGRIX as an immunocompromised patient, the clinician adds the code Requires vaccination against shingles.
- The individual responsible for running searches can then run the search in the main folder "Clinically reviewed for invitation for shingles vaccination. Invite the population included, adding an invitation code to each patient (see below for codes).
Clinically reviewing for eligibility
The report helps users to manually review those patients who have an eligible condition or are on immunosuppressive medication. Patients with a condition should be automatically eligible, but if a patient is only shown with data relating to medication it will be necessary to calculate the dose. As shown below, the Green Book specifies some daily and weekly doses for certain medications which cannot be filtered in an EMIS search.
- Patients taking Methotrexate 2.5mg tablets may be on a low dose such as 3 or 4 tablets a week (7.5-10mg/week), or they may be taking 8 or 10 (20-25mg/week), so excluding 2.5mg tablets was not an option
- Patients may be taking Methotrexate 2.5mg tablets in combination with leflunomide or prednisolone which would make them eligible
- For similar reasons to above, identifying long or short course high dose prednisolone is not factored into the cohort search
- The report PA-348a includes systemic corticosteroids alongside the immunosuppressive medication to assist decision making based on therapeutic dose
- Patients in PA-348a who also have another clinical indication would be already defined as eligible, so a calculation of daily/weekly dose is not necessary.
Some patients listed in PA-348 report may show a blank row, or only have immunosuppressive medication in the past. In these instances, the patient should have received their first shingles dose (whilst they were immunosuppressed) but is no longer on the medication. These patients remain eligible to receive a second dose at the 8 week interval up until their 80th birthday.
Targeted recall
These searches are available for those Practices who wish to send customised invitations for a specific cohort. All patients appearing in these searches will also appear in PA-344 or PA-349.
Turning 80 for final shingles recall
Patients who are aged between 79y6m and 79y11m who have not previously had a dose. These patients should have been previously invited when they were 70.
Turned 70 for shingles invitation
Patients who are aged between 70y0m and 70y2m. Regular running of this search and inviting patients accordingly will ensure they are invited and ready to receive their 1st dose soon after their 70th birthday.
Using a relative run date of a couple of weeks in the future will also capture patients who are technically not yet eligible (eg: if today is 01/09/2024, set the relative run date to 15/09/2024). This approach can be used to invite patients just prior to their 70th birthday, allowing time to generate the invitation, book the patient in for an appointment in a couple of weeks - assuming this is a typical lead time for routine vaccination appointments.Patients who already received a shingles vaccine privately will not be included as long as the vaccination has been coded correctly.
Turned 65 for shingles catch-up invitation
Patients born after 1st September 1958 who are between 65y0m and 65y2m. Regular running of this search and inviting patients accordingly will ensure they are invited and ready to receive their 1st dose soon after their 65th birthday.
Using a relative run date of a couple of weeks in the future will also capture patients who are technically not yet eligible (eg: if today is 01/09/2024, set the relative run date to 15/09/2024). This approach can be used to invite patients just prior to their 70th birthday, allowing time to generate the invitation, book the patient in for an appointment in a couple of weeks - assuming this is a typical lead time for routine vaccination appointments.
Age 80 and due 2nd vaccine
This is a child of the above search, provided as a final opportunity to chase patients whose 81st birthday is within the next few months and ensure they receive a 2nd dose. Regular follow up of the above search will mean this is likely to remain 0.
Data Admin
Contraindicated to shingles vaccine
This search maintains a code which existed prior to the introduction of Shingrix. If patients appear in this search, consider reviewing the patient record to establish when the code was added, and whether Shingrix is appropriate. Patients who have received a vaccination (likely Shingrix) are removed from this search.
Declined shingles vaccine
This search and report perform a dual function. It lists all patients who have declined a shingles vaccine at any time, but the report also highlights where EMIS codes were used to decline a shingles vaccination since these are not counted for QOF VI004.
Patients who have declined remain eligible for a vaccine until their 80th birthday. They will not appear in the "All eligible patients" search in the top level folder. Practices may wish to consider adding a child search with their own threshold for sending a further invitation to those who have declined, perhaps to those who are 78 and declined more than 3 or 5 years ago.
CHECK 2 coded doses of shingles vaccine
A data quality search which picks up combinations of vaccine codes which should not exist:
- Two single dose vaccine codes recorded on separate days
- A single dose vaccine code followed by a two dose vaccine code on later date
- A two dose vaccine code followed by a single dose vaccine code on a later date
Use the report to review the coding. It may be appropriate to amend coding in records to ensure the recall searches only pick up the correct patients.
Shingles vaccination given
These searches are not age sensitive, meaning they will pick up patients who have had their 80th birthday and were in the early NHS eligible cohorts, as well as younger patients who may have received a vaccination privately. These searches should not be touched as they are used to excluded patients from the invitation searches.
Received ZOSTAVAX 1 dose
Patients who were coded with either the old single dose code, or the new single dose code (from September 2023). This is a complete course.
If a patient was coded with single dose codes but received Shingrix, they will appear here, but they will also appear in the Data Quality search.
Received SHINGRIX 1st dose
Patients who have been coded with just one code representing the Shingrix vaccination, before their 80th birthday. The Enhanced Service requires that codes are added in the correct 'first - second' order but this has been built to accept any combination of valid vaccination codes. This is an incomplete course, and the number of patients should be relatively low - primarily those patients who were given their 1st dose recently.
Received SHINGRIX 2nd dose
Patients who have been coded with valid vaccination codes on two separate days. This is a complete course.
Coding
Relevant coding for vaccination administration is provided below. Vaccination codes themselves can be found on PCIT templates, and in other articles on this support centre.
Invitation
SNOMED | Term |
895931000000104 | Herpes zoster vaccination invitation |
896011000000102 | Herpes zoster vaccination invitation first letter |
896031000000105 | Herpes zoster vaccination invitation second letter |
896051000000103 | Herpes zoster vaccination invitation third letter |
896091000000106 | Herpes zoster vaccination invitation email |
896071000000107 | Herpes zoster vaccination invitation SMS |
Declined
| SNOMED | Term |
| 9691000175102 | Herpes zoster vaccination declined |
| 723062007 | Varicella zoster vaccination declined by patient |
Contraindicated
| SNOMED | Term |
| 868531000000103 | Herpes zoster vaccination contraindicated |
Requires shingles vaccination
| SNOMED | Term |
| 1730561000000103 | Requires vaccination against shingles |
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