How can secondary care-based clinicians access and use primary care-held vaccination data during a Paediatric Emergency Department attendance?

Isba, Rachel and Knight, Joanne and Davies, Nigel (2023) How can secondary care-based clinicians access and use primary care-held vaccination data during a Paediatric Emergency Department attendance? PhD thesis, Lancaster University.

Text (2023isbamdPhD)
2023isbamd.pdf - Published Version
Download (4MB)

Abstract

Background Before the SARS-CoV2/COVID pandemic, in the UK, coverage for some routine childhood vaccines e.g. MMR (measles, mumps, and rubella), were below global targets. A visit to hospital might provide an opportunity to offer a “catch-up” intervention to under-immunised children and young people, if clinicians could accurately identify them. Aims The overall aims were to look at sources of vaccination data available to clinicians working in the Paediatric Emergency Department (PED) and explore how an intervention might address under-vaccination. Methods A multiple methods pilot explored the feasibility and acceptability of delivering a brief public health intervention within a PED attendance. A scoping review summarised evidence for the delivery of interventions in hospitals to improve vaccination uptake in children and young people (CYP). Unmet vaccination need in under-fives was estimated via a cross-sectional observational study with a single data collection point for participants attending a large PED in Greater Manchester, in October 2021. Sources of vaccination data explored were: parent/carer recall, Child Health Information Services (CHIS), and Summary Care Records (SCRs). This was via a cross-sectional observational study (recall and SCRs) and a systems mapping approach (for CHIS). Results This work demonstrated that it was feasible and acceptable to deliver an intervention during a PED attendance and that vaccination interventions in hospital settings may be beneficial. There was considerable unmet need amongst children under the age of five years old, attending the PED, with extremely low levels of MMR coverage amongst those old enough to be eligible for two doses. Vaccination status was often over-estimated by parents/carers, CHIS were a definitive source of vaccination data but inaccessible to PED clinicians, and data within SCRs were presented in an inconsistent manner and often unstructured. Conclusion Whilst delivery of a vaccination-focused intervention during a PED attendance appears feasible, more work is needed to enable clinicians to identify those CYP with unmet vaccination need who might benefit from such an approach.