Characteristics of general practitioners associated with higher immunisation coverage

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Characteristics of general practitioners
associated with higher immunisation coverage

• Nikki Turner, Cameron Grant, Felicity
  Goodyear-Smith, Helen Petousis-Harris, Deon York,
  Rhys Jones, Jackie Copp

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(No Transcript)
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Aim To determine characteristics associated
with GPs working in practices that achieve higher
immunisation coverage and better timeliness of
delivery
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Design

• Part of larger project seeking to determine the
  contribution that different health care system
  factors make to immunisation coverage and
  timeliness at the general practice level.
• Survey of random sample 124 General Practices 70
  Auckland, 54 Midland region
• 38 decline rate, no difference in a range of
  characteristics no. enrollees, high needs,
  ethnicity, social deprivation

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Methods

• Practice immunisation coverage via electronic
  audit of PMS
• registered and enrolled immunised
• registered and enrolled delayed
• Correct sequence and date assumption
• Third dose assumption
• GP knowledge and attitudes
• 1 randomly selected GP per practice
• CATI
• Questionnaire adapted from previous NZ and UK
  questionnaires
• Descriptive analysis of coverage and doctor
  knowledge and attitudes
• Multivariate analysis of how various GP factors
  were associated with coverage and timeliness

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2. Results sources of information

• gt 90 GPs information sourced from
• PN
• NZ Immunisation Handbook
• Internet main source for 61 (54)
• CDC, MOH, WHO, IMAC, Google
• Other sources IMAC newsletter, Well
• Child Book, CME

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Immunisation information sources
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3. Results perceived barriers to achieving
immunisation
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4. Results comfort with their knowledge

• 96 believed immunisation to be important or
  very important.
• 5 GPs did not consider it important
• 93 were comfortable or very comfortable with
  their knowledge

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5. Results - knowledge

• 87 correct vaccine storage temperature 2
  80C
• 25 identified what CARM stood for
• 45 egg Allergy not contraindication to MMR
• 67 Treatment for leukaemia contraindication to
  MMR
• 20 stated they would delay MMR if child had
  snuffly cold

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Contraindications to MMR vaccine in a child
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5. Results age to immunise

• 88 (99) indicated 6 weeks
• 1 recommended 10 weeks, 3 recommended 12 weeks
• 9 (10) stated 6 weeks is too young /sometimes
  too young

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6. Results GP Educational Needs
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7. Results no association with practice
coverage

• Gender
• Comfortable with their knowledge of immunisation
• Rural versus non-rural
• Correctness of knowledge about true and false
  contraindications to measles and pertussis
  immunisation, except for identifying leukemia as
  a contraindication

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7. Results - associations with practice
coverage

• GPs who immunised (8) of practices
• - no difference in coverage but more likely to
  have timely delivery
• After adjustment for social deprivation of the
  practice, GP perception that parental apathy was
  a barrier was associated with lower coverage (P
  0.01) and more delay (p0.02)
• More frequent use of the Immunisation Handbook
  associated with higher practice coverage (lt0.02)
  and less delay (p0.007)
• Practices where GP correctly identified what
  CARM stood for had higher coverage0.006) and
  timeliness (p0.008)
• Practices with GP who correctly identified
  leukaemia as a contraindication to MMR had higher
  coverage (p0.01)

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Table 4.5.15 Associations of general practitioner
characteristics and their perceptions of parental
barriers to immunisation with immunisation
coverage and delay

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Conclusions

• Timely delivery more likely in practices where
  GPs also vaccinate
• Practices with GPs who have increased use of
  immunisation resources had better coverage and
  timeliness
• GP correctness of knowledge not usually
  associated with practice coverage or timeliness

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Concerns

• 12 GPs who consider 6 weeks may be too young to
  start immunising
• 4 of GPs did not consider immunisation to be
  important
• Significant GP knowledge gaps
• Though may not be impacting hugely on
  immunisation coverage overall (role of PN)