A process evaluation of how the routine vaccination programme is implemented at GP practices in England
A process evaluation of how the routine vaccination programme is implemented at GP practices in England
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DOI：
10.1186/s13012-018-0824-8
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发表时间：
2018-10-22
影响因子：
7.2
通讯作者：
Mounier-Jack, Sandra
中科院分区：
文献类型：
--
作者：
Crocker-Buque, Tim;Edelstein, Michael;Mounier-Jack, Sandra
近年来，欧洲几种具有公共卫生重要性的病原体（麻疹、腮腺炎、百日咳和风疹）的发病率有所增加，导致疫情爆发。这包括英格兰，那里的全科医生根据政府的指导实施疫苗接种计划。然而，目前还没有关于如何实施的研究，这使得很难确定组织差异，从而限制了推荐干预措施以提高覆盖率的能力。本研究的目的是承担在英格兰全科医生实践的常规疫苗接种计划的实施比较过程评估。方法：我们通过国家研究网络招募了地理和人口分布不同的全科医生实践样本，并收集了定量和定性数据，作为2017年5月至2018年2月期间时间驱动的基于活动的成本核算分析的一部分。我们对参与疫苗接种的执业人员进行了半结构化访谈，然后他们完成了为期两周的活动日志。访谈使用框架方法进行转录和编码。结果9家诊所完成了来自不同地理和社会经济背景的数据收集，52名临床和非临床工作人员参加了26次访谈。利用活动日志获取了与372次疫苗接种预约（233次儿童预约和139次成人预约）有关的信息。我们确定了14个阶段的保健服务价值链和详细的疫苗接种流程图。差异最大的领域包括提醒和召回活动的方法、疫苗接种预约的结构以及工作人员小组之间的任务分配。对于儿童疫苗接种，平均预约时间为15.9分钟（范围为9.0-22.0分钟），成人为10.9分钟（范围为6.8-14.1分钟）。非临床管理活动占总活动的59.7%（范围48.4-67.0%）。预约时长和总时间与覆盖率无关，而按每位符合条件的患者预约的能力可能会提高覆盖率。管理任务的实现保真度较低。结论：英格兰全科医生实施常规疫苗接种计划的方式存在差异。需要进一步的工作来评估更广泛实践中的能力因素，以及其他背景因素，包括实践中的工作文化。
BackgroundIn recent years, the incidence of several pathogens of public health importance (measles, mumps, pertussis and rubella) has increased in Europe, leading to outbreaks. This has included England, where GP practices implement the vaccination programme based on government guidance. However, there has been no study of how implementation takes place, which makes it difficult to identify organisational variation and thus limits the ability to recommend interventions to improve coverage. The aim of this study is to undertake a comparative process evaluation of the implementation of the routine vaccination programme at GP practices in England.MethodsWe recruited a sample of geographically and demographically diverse GP practices through a national research network and collected quantitative and qualitative data as part of a Time-Driven Activity-Based Costing analysis between May 2017 and February 2018. We conducted semi-structured interviews with practice staff involved in vaccination, who then completed an activity log for 2weeks. Interviews were transcribed and coded using a framework method.ResultsNine practices completed data collection from diverse geographic and socio-economic contexts, and 52 clinical and non-clinical staff participated in 26 interviews. Information relating to 372 vaccination appointments (233 childhood and 139 adult appointments) was captured using activity logs. We have defined a 14-stage care delivery value chain and detailed process map for vaccination. Areas of greatest variation include the method of reminder and recall activities, structure of vaccination appointments and task allocation between staff groups. For childhood vaccination, mean appointment length was 15.9min (range 9.0-22.0min) and 10.9min for adults (range 6.8-14.1min). Non-clinical administrative activities comprised 59.7% total activity (range 48.4-67.0%). Appointment length and total time were not related to coverage, whereas capacity in terms of appointments per eligible patient may improve coverage. Administrative tasks had lower fidelity of implementation.ConclusionsThere is variation in how GP practices in England implement the delivery of the routine vaccination programme. Further work is required to evaluate capacity factors in a wider range of practices, alongside other contextual factors, including the working culture within practices.