Health Catch-UP!:对英国初级保健中针对高危移民患者的创新型多疾病筛查和疫苗接种工具进行的现实主义评估。

IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Jessica Carter, Lucy P Goldsmith, Felicity Knights, Anna Deal, Subash Jayakumar, Alison F Crawshaw, Farah Seedat, Nathaniel Aspray, Dominik Zenner, Philippa Harris, Yusuf Ciftci, Fatima Wurie, Azeem Majeed, Tess Harris, Philippa Matthews, Rebecca Hall, Ana Requena-Mendez, Sally Hargreaves
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引用次数: 0

摘要

背景:来到英国的移民面临着过高的感染、非传染性疾病和免疫接种不足的风险,再加上医疗保健方面的障碍。目前英国的移民筛查策略不规范,实施效果差,接受率低。Health Catch-UP!是一个合作制作的数字临床决策支持系统,它应用当前的指导方针(英国卫生与健康协会和 NICE),为初级保健专业人员提供个性化的多种疾病筛查(7 种传染病/血液传播病毒、3 种慢性寄生虫感染、3 种非传染性疾病或风险因素),并为移民患者提供补种疫苗提示:我们采用医学研究委员会的复杂干预评估框架,在两个城市的初级医疗保健实践中对 "健康抓住你!"进行了混合方法的过程评估,以将 "健康抓住你!"整合到初级医疗保健的电子健康记录系统中。我们收集了定量数据(人口统计学、接受筛查的患者、疾病检测和补种疫苗率)和定性参与者访谈,以探讨可接受性和可行性:在两个地点(S1、S2)对 99 名移民进行了健康补种评估。96.0%(n = 97)的移民拥有完整的人口统计学编码,其中亚洲占 31.3%(n = 31),非洲占 25.2%(n = 25),这是最常见的出生大洲(S1 n = 92 [48.9% 为女性(n = 44);平均年龄 60.6 岁(SD 14.26)];S2 n = 7 [85.7% 为男性(n = 6);平均年龄 39.4 岁(SD 16.97)]。61.6%(n = 61)的参与者符合至少一种疾病的筛查条件,筛查率高达 86.9%(n = 53)。发现了 12 种新疾病(占研究人群的 12.1%),包括丙型肝炎(1 例)、高胆固醇血症(6 例)、糖尿病前期(4 例)和糖尿病(1 例)。健康接种!发现 100%(n = 99)的患者没有免疫接种记录;然而,随后的补种接种率很低(2.0%,n = 1)。定性数据从员工和患者的角度证明了健康捕捉-UP!的可接受性和可行性,并建议将健康捕捉-UP!整合到常规护理(如国民保健服务体系的健康检查)中,实施一揽子方案,包括员工和患者支持材料、标准化护理路径(筛查和补种疫苗、实验室和管理)以及经济激励:临床决策支持系统(如 Health Catch-UP!
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Health Catch-UP!: a realist evaluation of an innovative multi-disease screening and vaccination tool in UK primary care for at-risk migrant patients.

Background: Migrants to the UK face disproportionate risk of infections, non-communicable diseases, and under-immunisation compounded by healthcare access barriers. Current UK migrant screening strategies are unstandardised with poor implementation and low uptake. Health Catch-UP! is a collaboratively produced digital clinical decision support system that applies current guidelines (UKHSA and NICE) to provide primary care professionals with individualised multi-disease screening (7 infectious diseases/blood-borne viruses, 3 chronic parasitic infections, 3 non-communicable disease or risk factors) and catch-up vaccination prompts for migrant patients.

Methods: We carried out a mixed-methods process evaluation of Health Catch-UP! in two urban primary healthcare practices to integrate Health Catch-UP! into the electronic health record system of primary care, using the Medical Research Council framework for complex intervention evaluation. We collected quantitative data (demographics, patients screened, disease detection and catch-up vaccination rates) and qualitative participant interviews to explore acceptability and feasibility.

Results: Ninety-nine migrants were assessed by Health Catch-UP! across two sites (S1, S2). 96.0% (n = 97) had complete demographics coding with Asia 31.3% (n = 31) and Africa 25.2% (n = 25), the most common continents of birth (S1 n = 92 [48.9% female (n = 44); mean age 60.6 years (SD 14.26)]; and S2 n = 7 [85.7% male (n = 6); mean age 39.4 years (SD16.97)]. 61.6% (n = 61) of participants were eligible for screening for at least one condition and uptake of screening was high 86.9% (n = 53). Twelve new conditions were identified (12.1% of study population) including hepatitis C (n = 1), hypercholesteraemia (n = 6), pre-diabetes (n = 4), and diabetes (n = 1). Health Catch-UP! identified that 100% (n = 99) of patients had no immunisations recorded; however, subsequent catch-up vaccination uptake was poor (2.0%, n = 1). Qualitative data supported acceptability and feasibility of Health Catch-UP! from staff and patient perspectives, and recommended Health Catch-UP! integration into routine care (e.g. NHS health checks) with an implementation package including staff and patient support materials, standardised care pathways (screening and catch-up vaccination, laboratory, and management), and financial incentivisation.

Conclusions: Clinical Decision Support Systems like Health Catch-UP! can improve disease detection and implementation of screening guidance for migrant patients but require robust testing, resourcing, and an effective implementation package to support both patients and staff.

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来源期刊
BMC Medicine
BMC Medicine 医学-医学:内科
CiteScore
13.10
自引率
1.10%
发文量
435
审稿时长
4-8 weeks
期刊介绍: BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.
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