Community Influenza Collaborative: Prevention and Surveillance

State: ND Type: Model Practice Year: 2004

The Community Influenza Collaborative was first established in the fall of 2000 with the intent of addressing concerns caused by the delay in influenza vaccine distribution to the Cass County, ND and Clay County, MN area. This two-county area, with a population of approximately 200,000 people, is located within two bordering states and is served by two local health departments, two major health care systems, and several independent physician groups. The initial goal of this group was to initiate communication between the private and public health care sectors in regards to influenza prevention planning. Once that communication was established and barriers were identified and addressed, the group identified the following goals: develop a common message for the general public regarding influenza vaccination, educate all health care providers regarding CDC influenza vaccination guidelines and encourage them to adhere to these guidelines, establish consistency in timing for vaccination clinics throughout the community and consistency in vaccination costs, and develop a local influenza surveillance system. The outcomes of this collaborative have gone far beyond meeting the established goals. This group, which has grown over the past years, has become the cornerstone for community planning regarding communicable disease prevention and control. What started as a small group of nurses concerned about influenza planning has grown into a varied group of health care professionals dealing with communicable diseases, smallpox preparedness, SARS planning and public health emergency planning. Key elements required to replicate this practice include an agency willing to take the lead in development of the collaborative, open and honest communication, recognition of the distinct needs of private and public health care providers, and the underlying belief that working together for a common community goal is the responsibility of the entire health care community.
The past several influenza seasons have presented many challenges for both the public and private health care sector. Issues regarding influenza planning, vaccine availability, adherence to the Centers for Disease Control and Prevention (CDC) guidelines, and mixed messages to the general public first became of concern during the 2000-2001 influenza season and have continued since. A community plan was needed to address these growing concerns, a plan that included input and discussion from all parties involved. The Community Influenza Collaboration, known locally as the “flu committee,” was brought together in the fall of 2000 to specifically address the current challenges facing the community regarding the late delivery of flu vaccine. Since that time this group has continued to grow and expanded to address numerous communicable diseases and public health planning. Historically, communication between the private and public health care sector has been limited. Generally communication was geared towards specific patients and most often as a reaction to a specific problem. Rare was the opportunity where providers discussed common problems and searched for solutions to benefit the entire community. This was especially true in regards to influenza and other communicable disease control and prevention. Both private and public health care providers were aware of their roles, but not always aware of how these entities needed to work together with others in the community.
Agency Community Roles The Community Influenza Collaborative is a group of health care providers from the Fargo, ND and Moorhead, MN area that includes representation from hospitals, clinics, local college health facilities, public health, nursing homes, ambulance, and public information officers. Fargo Cass Public Health (FCPH) has taken the lead role in this collaborative and made the initial contacts with other local health care providers. FCPH continues as the lead agency in this effort, scheduling and chairing the meetings, serving as the main point of communication for the group, maintaining the membership list, and providing direction regarding public health issues and concerns. Other participants bring their own set of concerns to the group and the importance of the role of each agency is stressed. Costs and Expenditures This collaborative has become a positive venue for open communication and it is the responsibility of each participant to participate and share in the discussion and decision making. During the influenza season (generally September through March), the Community Influenza Collaborative meets at FCPH every other week to make plans for influenza prevention and surveillance and to discuss any new concerns and issues. During the remainder of the year, this group meets as needed to address any immediate communicable disease concerns. Due to the many new and emerging infectious diseases, and the need for community public health planning, this group has been very busy the past few years. This collaborative project has had minimal costs to the individual agencies. Staff time for attending meetings is the only established cost, and as participation in this project is a natural extension of each individual's own job responsibility, this time and cost are not seen as issues or deterrents for participation. Implementation Each fall this group meets and begins discussion for the upcoming flu season. Based on CDC recommendations, vaccination guidelines are established regarding high-risk populations, time frame for vaccination, and needs for allocation of available vaccine. Involved agencies work together to develop a consistent time frame for community vaccination clinics, and determine the cost for vaccination. A consistent community wide message is developed and utilized by all participating agencies. This group becomes the community “voice” for information regarding influenza. Press releases and educational information are distributed through this collaboration. During the 2003-2004 influenza season, there were again issues regarding vaccine availability. This group worked together to assure the use of available vaccine for those who needed it most. Lines of communication were open between providers, enabling them to refer patients to those clinics which had vaccine available. The development of a local influenza surveillance system was identified as a need during the initial year of this collaborative. This group wanted to have a way of capturing the bigger picture of what is happening in the community during an influenza season. A list of indicators was established that includes: school absentee rates, staff absentee rates, total number of clinic visits, clinic visits reporting influenza like symptoms, number of rapid influenza tests performed, number of positive rapid tests, number of anti-virals prescribed, nurse line calls regarding influenza like symptoms. Through collaborative partners, contacts were made with a pre-determined number of schools, worksites, clinics, pharmacies, and hospitals to provide data. Data is submitted on a daily or twice weekly basis to FCPH. The information is entered into an Excel data base which averages the information and creates graphs and charts which are monitored by staff from FCPH. A copy of the charts and graphs are sent out weekly to all participating organizations and collaborative partners. The goal of this system is to provide a method for real time surveillance and provides the collaborative with valuable information about what is happening in the community during the influenza season.
The process of frequent meetings before and during the influenza season has proven to be an effective strategy for this group. By having frequent scheduled meetings, the group is forced to stay on target, accomplish assigned tasks, and react to unforeseen problems in a quick and efficient manner. One of the most significant challenges has been how to assure that vaccine in the community is targeted to those who are at highest risk of complications from influenza. It has not been unusual to have one health care facility receive vaccine, while others in the community have none. Adherence to CDC recommendations is vital in this case. Another important element is letting go of the “my patient, your patient” attitude, and replacing it with one of identifying high-risk individuals in the community and directing vaccine towards those individuals. The development of this community collaboration and its ensuing projects can most effectively be evaluated by the short-term effects that the community has seen as a result of this group. First and foremost is the increase in communication between public and private health care providers. Relationships have been established, trust has been developed and a true sense of collaboration has developed. Health care providers no longer have to deal with issues and concerns regarding influenza alone, as this collaborative is available to assist in discussion and problem solving. The initial objectives developed by this group have been met during each of the past influenza seasons since the organization of this collaborative. Quantitative data as to the success of this project include: an increase in collaborative membership from six individuals the first year to approximately twenty individuals at the present time representing a wide variety of health systems, an increase in entities participating in the surveillance system from eight to fourteen, and an increase in the number of influenza vaccinations given through Fargo Cass Public Health from 4,292 during the 2001-2002 influenza season to over 6,500 during the 2003-2004 season. Qualitative data that supports the success of this project, though more difficult to measure, is made evident by improved communication between private and public health care providers, improved public trust in the health care system regarding influenza prevention, and a growing sense of community involvement and ownership of the process to help prevent influenza and other communicable diseases.
Sustainability Stakeholder commitment to this project is high; meeting attendance is good with active discussion and participation. Additional meetings are often triggered by stakeholder concerns as this collaborative is seen as a sound and respected decision making group. With the growing need for community planning regarding emerging infectious diseases and emergency public health planning, the importance to support and sustain this collaborative group is understood by all involved. Lessons Learned: Most notable is that collaboration between public and private health care providers regarding influenza has increased community trust in the health care system. No longer is the public receiving mixed messages about who should be vaccinated and when or where. Agencies are not being pitted against one another as having vaccine or not having vaccine. This group has also learned that combined information, as in the surveillance system, is of much more benefit to everyone then only seeing a small piece of the picture. One example is that when school and worksite absentee rates become high, local nursing homes become more in tune to the health of their own employees and of those who are visiting the residents. In implementing the surveillance system many lessons were learned about data efficiency, the importance of timely submission, and the importance of making the process easy for participating entities. The reliability of a surveillance system is only as good as the data that is obtained and entered. It is also vital to have someone involved with the surveillance system who not only has a good understanding of the epidemiology of influenza but also someone who is computer savvy. The health department was fortunate to have a local health officer whose passions were surveillance and data.