Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Department of Immunisation, Hepatitis and Blood Safety, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
Implement Sci. 2018 Oct 22;13(1):132. doi: 10.1186/s13012-018-0824-8.
In 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.
We 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 2 weeks. Interviews were transcribed and coded using a framework method.
Nine 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 15.9 min (range 9.0-22.0 min) and 10.9 min for adults (range 6.8-14.1 min). 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.
There 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.
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）的发病率有所上升，导致疫情爆发。英国也包括在内，英国的全科医生诊所根据政府指导实施疫苗接种计划。然而，对于实施情况的研究还没有，这使得确定组织差异变得困难，从而限制了推荐干预措施以提高覆盖率的能力。本研究的目的是对英国全科医生诊所常规疫苗接种计划的实施情况进行比较性的过程评估。
我们通过国家研究网络招募了具有地理和人口统计学多样性的全科医生诊所样本，并于 2017 年 5 月至 2018 年 2 月期间收集了定量和定性数据，作为时间驱动的基于活动的成本分析的一部分。我们对参与疫苗接种的实践工作人员进行了半结构化访谈，然后让他们填写了两周的活动日志。对访谈进行了转录和编码，使用了框架方法。
9 个实践从不同的地理和社会经济背景完成了数据收集，52 名临床和非临床工作人员参加了 26 次访谈。活动日志记录了 372 次疫苗接种预约（233 次儿童预约和 139 次成人预约）的信息。我们定义了一个 14 阶段的护理服务价值链，并详细绘制了疫苗接种的过程图。变化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之间的任务分配。对于儿童疫苗接种，每次预约的平均时间为 15.9 分钟（范围为 9.0-22.0 分钟），成人每次预约的平均时间为 10.9 分钟（范围为 6.8-14.1 分钟）。非临床行政活动占总活动的 59.7%（范围为 48.4-67.0%）。预约时间和总时间与覆盖率无关，而每个符合条件的患者的预约次数可能会提高覆盖率。行政任务的实施一致性较低。
英国的全科医生诊所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。
