Marszalek Milena, Hawking Meredith K D, Gutierrez Ana, Firman Nicola, Wu Jianhua, Robson John, Smith Kelvin, Dostal Isabel, Ahmed Zaheer, Bedford Helen, Billington Anna, Dezateux Carol
Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK.
Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK.
Vaccine. 2025 Jan 1;43(Pt 1):126522. doi: 10.1016/j.vaccine.2024.126522. Epub 2024 Nov 16.
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.
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.
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.
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.
National Institute of Health and Care Research; Barts Charity.
我们进行了一项混合方法评估，以评估利用数字呼叫和召回工具实施初级保健质量改进（QI）计划是否能提高首次麻疹、腮腺炎和风疹（MMR）以及白喉、破伤风、百日咳和含脊髓灰质炎疫苗（DTaP/IPV）接种的及时性和公平性。
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名儿童有资格接种首剂MMR和DTaP/IPV。我们使用中断时间序列分析比较了实施前后及时接种首剂MMR或DTaP/IPV的儿童比例（分别为18个月和6个月龄时）。我们通过地区层面的贫困指标计算不平等斜率指数（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。
及时接种首剂MMR的儿童比例增加了5.3%（率比[RR]：1.053，95%置信区间[CI]：1.033 - 1.073），相当于及时接种MMR的绝对增加4.1%——从77.7%增至81.8%，首剂DTaP/IPV接种比例增加了0.9%（RR：1.009，95% CI：1.003 - 1.015）。两种疫苗的SII均无显著变化。用户报告称使用该工具后召回情况有所改善，但指出了实践层面和系统层面的障碍，包括人员动态和无法实现的国家目标，限制了该工具的持续使用。
在现实环境中，初级保健QI计划中的呼叫和召回工具提高了首剂MMR接种的及时性。持续改进需要额外的支持，包括激励可实现的目标以及提高工作人员的能力和培训。
国家卫生与保健研究机构；巴茨慈善机构。
