GP 合同对流感免疫相关不平等的影响：一项回顾性人口数据库分析。
Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis.
机构信息
Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
出版信息
Br J Gen Pract. 2011 Jul;61(588):e379-85. doi: 10.3399/bjgp11X583146.
BACKGROUND
Influenza immunisation is recommended for all people aged ≥65 years and younger people with particular chronic diseases. The Quality and Outcomes Framework (QOF) has provided new financial incentives for influenza immunisation since 2004.
AIM
To determine the impact of the 2004 UK General Medical Services contract on the overall uptake of, and socioeconomic inequalities associated with, influenza immunisation.
DESIGN AND SETTING
Retrospective general-practice population database analysis in 15 general practices in Scotland, UK.
METHOD
Changes in influenza-immunisation uptake for those in at-risk groups between 2003-2004 and 2006-2007 were measured, and variation in uptake examined using multilevel modelling.
RESULTS
Uptake rose from 67.9% in 2003-2004 to 71.4% in 2006-2007. The largest increases were seen in those aged <65 years with chronic disease, with uptake rising from 49.6% to 58.4%, but rates remained considerably lower than in those aged ≥65 years. Differences between practices narrowed (median odds ratio [OR] for two patients randomly selected from different practices: 2.13 (95% confidence interval [CI] = 2.00 to 2.26) in 2003-2004 versus 1.44 (95% CI = 1.40 to 1.49) in 2006-2007. However, inequalities in uptake by patient socioeconomic status did not change: adjusted OR for most deprived versus most affluent was 0.75 (95% CI = 0.70 to 0.80) in 2003-2004 versus 0.72 (95% CI = 0.68 to 0.76) in 2006-2007.
CONCLUSION
Overall uptake rose significantly and differences between practices narrowed considerably. However, socioeconomic and age inequalities in influenza immunisation persisted in the first 3 years of the QOF. This contrasts with other ecological analyses, which have concluded that the QOF has reduced inequalities. The impact of financial incentives on inequalities is likely to vary, and some kinds of care may require more targeted improvement activity and support.
背景
流感疫苗接种推荐给所有年龄≥65 岁的人群和患有特定慢性病的年轻人群。自 2004 年以来，质量和结果框架（QOF）为流感疫苗接种提供了新的经济激励措施。
目的
确定 2004 年英国全科医生服务合同对流感疫苗接种的总体接受率以及与流感疫苗接种相关的社会经济不平等的影响。
设计和设置
在英国苏格兰的 15 家全科诊所中，对具有特定风险的人群的流感疫苗接种情况进行回顾性的一般实践人群数据库分析。
方法
测量 2003-2004 年和 2006-2007 年之间处于高危人群的流感疫苗接种率的变化，并使用多层次模型检查接种率的变化。
结果
接种率从 2003-2004 年的 67.9%上升到 2006-2007 年的 71.4%。在患有慢性病的<65 岁人群中，接种率的增幅最大，从 49.6%上升到 58.4%，但仍远低于≥65 岁的人群。不同诊所之间的差异缩小（从不同诊所随机选择的两名患者的中位数优势比（OR）：2003-2004 年为 2.13（95%置信区间[CI]：2.00 至 2.26），而 2006-2007 年为 1.44（95%CI=1.40 至 1.49）。然而，患者社会经济地位的接种率不平等并未改变：2003-2004 年最贫困与最富裕的调整后 OR 为 0.75（95%CI=0.70 至 0.80），而 2006-2007 年为 0.72（95%CI=0.68 至 0.76）。
结论
总体接种率显著上升，诊所之间的差异大大缩小。然而，QOF 实施的前 3 年，流感疫苗接种在社会经济和年龄方面的不平等仍然存在。这与其他生态分析形成对比，后者得出结论认为 QOF 减少了不平等。经济激励对不平等的影响可能有所不同，某些类型的护理可能需要更有针对性的改进活动和支持。
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