This annual report - Taranaki District Health Board

Giuffrida A, et al. 1999. Target payments in primary care: effects on professional practice and health careoutcomes. Cochrane Database of Systematic Reviews doi:10.1002/14651858.CD000531http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000531/abstractThis review examined the effect of target payments on the professional practice of primary care physicians (PCPs) andhealth care outcomes. Only two RCTs (involving 149 practices) were included in the review, both of which assessed theeffect of target payments on immunisation rates. One study (313 PCPs, 6,600 2 year olds and 6,400 5 year olds)assessed the effect of target payments on immunisation rates using an interrupted time series design. Before 1 April1990 GPs received a fee for each immunisation made. After 1 April 1990, a lump sum payment was made if GPsimmunised at least 70 per cent of the eligible population (a higher rate of payment was paid to the GPs that reached a 90per cent target), but nothing was paid if they immunised less than the lower target. Immunisation rates improved after theintroduction of target payment, however, a logistic regression model of the trend found that there was no evidence thatthe overall linear trend had changed as a result of the introduction of target payments.Other Systematic ReviewsGlenton C, et al. 2011. Can lay health workers increase the uptake of childhood immunisation? Systematic reviewand typology. Tropical Medicine & International Health, 16(9), 1044-53.This review assessed the effects of lay health workers (LHWs) on childhood immunisation uptake. Twelve studies,(including 10 RCTs) were included in the review, mostly comparing LHWs with no intervention or standard care. Seven ofthe studies were conducted among economically disadvantaged populations in high-income countries (LHWs madehome visits to parents to promote routine childhood immunisations and encourage clinic visits for vaccination), and theremaining five studies were conducted in low and middle income countries (in some of which LHWs gave vaccinations).Most of the studies showed that LHWs increased immunisation coverage. The diversity of settings meant the metaanalysiswas possible for only four of the studies, all in high income settings (3568 participants). These LHWprogrammes were associated with a statistically significant increased the number of children whose immunisations wereup to date (RR 1.19, 95% CI 1.09 to1.30). The authors conclude that while LHWs show promise in improving vaccinationcoverage, further high quality studies are need in low and middle income countries.National Collaborating Centre for Women’s and Children’s Health. 2009. Reducing differences in the uptake ofimmunisations (including targeted vaccines) in children and young people aged under 19 years: systematicreview of effectiveness and cost effectiveness evidence. London: National Collaborating Centre for Women’s andChildren’s Health. http://www.nice.org.uk/PH21This review provides the evidence base for the NICE guidance (available at http://www.nice.org.uk/PH21) on reducingdifferences in uptake of immunisations. The review is focussed on what interventions are effective and cost effective inreducing differences in immunisation uptake in children and young people aged under 19 years. The effectivenessreview included 142 studies and the cost-effectiveness review included 10 studies. Three key themes were identified:issues relevant to all childhood vaccines; issues relevant to MMR as an exemplar of a universal vaccine; issues relevantto neonatal Hep B as an exemplar of a targeted vaccine. Interventions assessed included: recipient reminder/recallsystems; home visits; client or family incentives/disincentives; interventions in school or day care settings; provider basedinterventions (including education, reminders and incentives); national immunisation programmes; and multi-componentinterventions. A review of studies examining barriers to immunisation and the views and experiences of children, youngpeople, parents/carers, and health professionals is included. Only one study included evaluated differential uptake ofimmunisations across population subgroups, although numerous studies assessed targeted interventions. The executivesummary provides 66 effectiveness evidence statements and three cost-effectiveness evidence statements. The qualityof included studies was variable and while there were some RCTs included, only 16 intervention studies had the highestquality rating. Evidence-based recommendations include: improve access to immunisation services, for example, by extending clinic times and making sure clinics are ‘childfriendly’ provide parents and young people with tailored information and support and an opportunity to discuss any concerns check children and young people’s immunisation status during health appointments and when they join nurseries,playgroups, schools and further education colleges, and offer them vaccinations ensure babies born to hepatitis B-positive mothers are given all recommended doses of the vaccine on time, ablood test to check for infection and, where appropriate, hepatitis B immunoglobulin.Falagas ME & Zarkadoulia E. 2008. Factors associated with suboptimal compliance to vaccinations in children indeveloped countries: a systematic review. Current Medical Research and Opinion, 24(6), 1719-41.This review evaluated factors associated with suboptimal compliance to vaccinations, focussed on children andadolescents in developed countries. Thirty-nine original studies were included in the review. Factors influencingcompliance with vaccinations were divided into parental-childhood characteristics and healthcare structure-healthprofessionals characteristics. Parent-childhood characteristics that were statistically significantly associated withsuboptimal compliance were: non-white race, low socioeconomic status, paying for vaccination, lack of health insurance,low parental education, older age of the child, younger maternal age, large family size, late birth order, lack of knowledgeabout disease and vaccination, negative beliefs/attitudes towards vaccination, fear of side-effects/risks/contraindications,not remembering vaccination schedules and appointments, sick child delays, and delayed well child visits. Factorsrelated to healthcare structures and health professionals that were statistically significant associated with suboptimalcompliance included: scepticism/doubts regarding provided medical information, inadequate support from healthcareproviders, lack of available health structures, and problems concerning transportation and accessibility to vaccinationclinics. The authors suggest that by understanding factors associated with suboptimal compliance, efforts to improvecompliance can be better targeted.Immunisation Coverage - 168