提高学龄前儿童接种疫苗的及时性和公平性：对初级保健质量改进计划的混合方法评估。

IF 4.5 3区医学 Q2 IMMUNOLOGY

Vaccine Pub Date : 2024-11-16 DOI:10.1016/j.vaccine.2024.126522

Milena Marszalek , Meredith K.D. Hawking , Ana Gutierrez , Nicola Firman , Jianhua Wu , John Robson , Kelvin Smith , Isabel Dostal , Zaheer Ahmed , Helen Bedford , Anna Billington , Carol Dezateux

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引用次数: 0

摘要

背景：方法：2019 年 1 月 1 日至 2024 年 1 月 31 日期间，伦敦东北部分别有 138,133 名和 136,952 名儿童符合接种首次麻疹、腮腺炎和风疹（MMR）以及白喉、破伤风、百日咳和脊髓灰质炎（DTaP /IPV）疫苗的条件。我们采用间断时间序列分析法比较了实施前和实施后及时接受首次 MMR 或 DTaP/IPV 的比例（分别为 18 岁和 6 个月）。我们通过地区一级的贫困衡量标准计算了不平等斜率指数（SII）的变化。我们对用户进行了 "大声思考 "练习和半结构化访谈：及时接受首次麻腮风疫苗接种的儿童比例增加了 5-3%（比率比 [RR]：1-053，95% 置信区间 [CI]：1-033-1-073），相当于及时接受麻腮风疫苗接种的绝对比例增加了 4-1%（从 77-7% 增加到 81-8%），首次接种 DTaP/IPV 的比例增加了 0-9%（比率比：1-009，95% 置信区间：1-003-1-015）。两种疫苗的 SII 均无明显变化。使用者报告称，使用该工具后回忆能力有所提高，但也发现了实践层面和系统方面的障碍，包括人员动态和无法实现的国家目标，这些都限制了该工具的持续使用：在实际环境中，初级保健质量改进计划中的呼叫和召回工具提高了首次接种麻腮风疫苗的及时性。持续改进需要额外的支持，包括激励实现可达到的目标，提高员工能力和培训：国家健康与护理研究所；巴兹慈善机构。

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Improving the timeliness and equity of preschool childhood vaccinations: Mixed methods evaluation of a quality improvement programme in primary care

Background

We conducted a mixed methods evaluation to assess whether implementing a primary care quality improvement (QI) programme utilising a digital call-and-recall tool improved timely receipt and equity of first measles, mumps and rubella (MMR) and diphtheria tetanus, pertussis and polio-containing (DTaP /IPV) vaccinations.

Methods

138,133 and 136,952 children were eligible to receive first MMR and DTaP/IPV respectively between 1st January 2019 and 31st January 2024 in North East London. We compared proportions with timely first MMR or DTaP/IPV receipt (by ages 18 and six months respectively) pre- and post-implementation using an interrupted time series analysis. We calculated change in the Slope Index of Inequality (SII) by an area-level deprivation measure. We conducted ‘Think Aloud’ exercises and semi-structured interviews with users.

Findings

The proportion of children with timely first MMR receipt increased by 5·3 % (Rate Ratio [RR]:1·053, 95 % confidence interval [CI]:1·033–1·073), equating to an absolute increase in timely MMR receipt of 4·1 % - from 77·7 % to 81·8 % - and for first DTaP/IPV by 0·9 % (RR:1·009, 95 % CI:1·003–1·015). There was no significant change in SII for either vaccine. Users reported improved recall with tool use, but identified practice-level and systemic barriers, including staff dynamics and unachievable national targets, limiting its consistent use.

Interpretation

In a real-world setting, a call-and-recall tool within a primary care QI programme improved timely first MMR receipt. Sustained improvement requires additional support including by incentivising achievable targets and improving staff capacity and training.

Funding

National Institute of Health and Care Research; Barts Charity.

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来源期刊

Vaccine 医学-免疫学

CiteScore

8.70

自引率

5.50%

发文量

992

审稿时长

131 days

期刊介绍： Vaccine is unique in publishing the highest quality science across all disciplines relevant to the field of vaccinology - all original article submissions across basic and clinical research, vaccine manufacturing, history, public policy, behavioral science and ethics, social sciences, safety, and many other related areas are welcomed. The submission categories as given in the Guide for Authors indicate where we receive the most papers. Papers outside these major areas are also welcome and authors are encouraged to contact us with specific questions.