Photo: Dr. Justin McGinnis, Gynecologic Oncologist
As COVID-19 becomes more manageable in Canada through the success of vaccinations, we have to turn our attention to another prevalent disease: influenza. Influenza was the most common infection-related cause of death in Canada, until the emergence of COVID-19. Despite its viral rampage across the world over the past two years, Dr. Justin McGinnis, Gynecologic Oncologist, believes that influenza will remain a very common source of morbidity for cancer patients in Canada. Cancer patients receiving chemotherapy are highly susceptible to contracting influenza, which can lead to secondary pneumonia, ICU admission, and death.
Prevention is the best solution, but, as the COVID-19 vaccination efforts have shown, jabbing a small needle into someone's arm is only one step in a process.
In the summer of 2020, McGinnis realized that many cancer patients presenting to the BC Cancer Agency (BCCA) were at risk of contracting the flu and hadn't been vaccinated because routine vaccinations were not a priority. He identified that an in-house flu vaccination clinic was critical for patient health and safety.
He had to identify and overcome some hurdles to devise a program that would vaccinate cancer patients,. It became clear that healthcare providers weren't asking cancer patients if they received the flu vaccine. Many of the patients that McGinnis worked with came from various areas of BC and Yukon, and travel to Vancouver for their cancer treatment. As they arrived at Vancouver General Hospital for their cancer surgery, there was no communication from the healthcare provider to the patient regarding flu vaccines.
The other major obstacle was that the BC Cancer Agency did not have a vaccination program, and their pharmacies did not stock flu vaccines.
By identifying these logistical barriers, McGinnis and his team created an inpatient vaccine program at VGH. Once patients were admitted to the hospital, healthcare providers talked to them about the flu vaccine, documented their vaccine history, and administered a pre-printed order (PPO) for influenza vaccination prior to discharge.
The program – which ran from November 1, 2020 to February 28, 2021 – resulted in a five percent overall increase in the influenza vaccination rate and rates were on average four times higher than the national average as reported by the Public Health Agency of Canada. McGinnis and his team saw this as a huge success given that this is the first year of the program.
Despite the overall success of the program, vaccine hesitancy was identified as the major barrier to vaccination. Some believed they don't need it because they never had the flu, and others viewed the flu vaccine as a lower priority compared to the various appointments and treatments for their new diagnosis of cancer.
Health care workers across the cancer care team need to support vaccinations for the campaign to have greater success in the future.
“It takes vaccine advocates. It doesn't have to be a physician, it really can be anybody to have that conversation with patients and make that firm recommendation," says McGinnis. “By emphasizing the severity of getting some of these infections, including death, I think you can convince people that it's important."
McGinnis learned through the project that care providers at VGH are really eager to engage in quality improvement and do as much as possible to improve patient outcomes. When working with people who share the same mindset, every small change can make a big impact, he believes. “By introducing very simple changes such as the pre-printed order set that takes patients only a couple of minutes to fill out, can induce quite a bit of change. Thirty percent of all vaccinated people in our study were done through this simple program," McGinnis concluded.
This was his first year working in B.C., and McGinnis was unfamiliar with the many layers of administration and overall structure of the medical team at the Vancouver Acute Community of Care. He credits the VCH/PHC Physician Led Quality Improvement team for their significant contribution to the success of the project, as they helped him connect with others who also had a passion for quality improvement in Vancouver. The partnership with VCH Team Based Quality Improvement (TBQI) clinicians helped drive this project forward. “I can see from conversations that I'm going to have a great community of people to collaborate with going forward."
Vaccine hesitancy was around long before the COVID-19 pandemic, and this year may have magnified its effects. It's a problem with a long history, regardless of vaccine. Healthcare professionals will continue to wrestle with it, but projects like McGinnis' that make access to vaccines easier, may help increase patient participation.
The Physician-Led Quality Improvement (PLQI) Initiative at VCH and PHC is a province wide initiative and a partnership between Vancouver Coastal Health, Providence Health Care, and the Specialist Services Committee . PQI is a flagship initiative of the Specialist Services Committee, one of four Joint Collaborative Committees funded by Doctors of BC and the BC government. PQI has supported this initiative and many others that are making a real difference to promote innovation in our health care system. For more information, go to https://sscbc.ca/physician-engagement/regional-quality-improvement-initiative.
Dr. Justin McGinnis is a Gynecologic Oncologist at Vancouver Coastal Health.
