General practitioners' perceptions on pneumococcal vaccination for children in United Kingdom.

Following the introduction of the pneumococcal conjugate vaccination program for children in the UK, a study of General Practitioners in Walsall and Liverpool was undertaken to identify the possible reasons for the delay in implementation of the program. A total of 143 GPs were contacted, of whom 39 responded (response rate = 27%). One-third of the GPs felt that there was 'delay' in the introduction of the program. The main reasons for possible delay in the implementation of the program were 'problems with databases', 'inadequate/unclear information from Primary Care Trust,' 'lack of public awareness' and 'parental delay.' Twelve percent of the respondents said that issue of 'payment' to them was the reason for not implementing the program. Most of the reasons given were 'external' to the practitioners. This being an initial exploratory study of its kind, the authors recommend that the results of this study be used in conjunction with other quantitative data by commissioners of health services in designing the implementation of a new vaccination program.

Developing performance indicators for primary care: Walsall's experience.

BACKGROUND: There has been increasing interest in the development of performance indicators in primary care, especially since the introduction of the Quality and Outcomes Framework (QOF). Public health and primary care trusts collect a range of data from routine or non-routine sources that may be useful for this purpose. AIM: To assess whether performance against the QOF is a robust measure of practice performance when compared with health-inequality indicators and to contribute to the development of a tool to monitor and improve primary care services. DESIGN OF STUDY: A retrospective cross-sectional study. SETTING: Sixty-three GP practices contracted with Walsall Teaching Primary Care Trust. METHOD: Correlation analysis and scatter plots were used to identify possible significant relationships between QOF scores and health-inequality data. The study also utilised confidence limit theory and control chart methodology as tools to identify possible performance outliers. RESULTS: Little correlation was found between overall QOF score and deprivation score. Uptake of flu immunisation (r2=0.22) and cervical screening (r2=0.11) both showed a slight increase with increased QOF score. Benzodiazepine (r2=0.06) and antibiotic prescribing levels (r2=0.02) decreased slightly with increased QOF scores, although not significantly. An increase in practice-population deprivation score was correlated with a reduction in cervical screening uptake (r2=0.27) and an increase in benzodiazepine prescribing (r2=0.25). Statistically significant relationships were found between the patient: GP ratio and flu immunisation uptake (r2=0.1) and antibiotic prescribing (r2=0.1). The majority of GPs found it acceptable to use performance indicator data as part of their annual appraisal. CONCLUSION: QOF and health-inequality data can be used together to measure practice performance and to develop tools to help identify areas for performance development and the sharing of best practice.

Evaluation of an independent, radiographer-led community diagnostic ultrasound service provided to general practitioners.

BACKGROUND: Health care services traditionally offered in a secondary setting are increasingly being offered in a primary setting. There has been little assessment of quality and efficiency of diagnostic services such as ultrasound delivered in primary settings and no studies have looked at independently provided services. AIMS: To assess the benefits and disadvantages of a radiographer delivered, primary care-based mobile diagnostic ultrasound service by comparing it to an NHS Trust diagnostic ultrasound service. DESIGN: A retrospective, comparative study. SETTING: A primary care area in the West Midlands. METHOD: Random samples of 200 and 193 adult patients who underwent diagnostic ultrasound in 2001/2002 with the community and NHS Trust services respectively, and all GP principals in the area were identified. Patient access (including wait for appointments), patient and GP satisfaction, clinical quality of services, and cost-effectiveness were assessed by postal questionnaires, interviews, review of stored ultrasound images, patient record review and collection of data on unit costs. RESULTS: Mean wait for an appointment was 17.44 (15.85-19.02) and 44.53 days (38.83-50.23) for the community and NHS Trust services respectively. Response rates from the community and hospital patient groups were 52.9 percent and 44.6 percent, respectively. Demographic characteristics of the two groups of respondents did not differ significantly, therefore justifying comparison between the two groups of respondents. High proportions of patients from both services reported time and location of appointment as convenient. Access to secondary care following an abnormal ultrasound was not systematically different for the services. Patients were highly satisfied with both services. GPs were markedly less satisfied with the NHS Trust service compared to the community service. Quality of stored ultrasound images and reports were comparable for the services. Cost per abnormality detected was higher for the community service (107.69 pound sterling compared to 77.35 pound sterling for the NHS Trust service, not statistically significant). CONCLUSION: The community diagnostic ultrasound service offers reduced waiting times compared to the NHS Trust service, and is of comparable quality. This benefit, together with high patient and GP satisfaction levels, may justify the possible reduced cost-effectiveness of the service compared to the NHS Trust service.

An outbreak of mumps in the metropolitan area of Walsall, UK.

OBJECTIVE: To describe the epidemiology of excessive mumps cases during the year 2000, within the metropolitan area of Walsall, UK; to assess the impact of the mumps outbreak on morbidity; and to inform future communicable disease control strategy. METHODS: Demographic records, school attendance, uptake of the measles-mumps-rubella (MMR) vaccine, and mumps-associated admission to hospital, were reviewed for all Walsall residents diagnosed and notified with mumps during the year 2000. RESULTS: There were 200 mumps notifications in 2000 (76.6 per 100,000), representing the highest incidence in England. Only 91 of the notified cases were salivary antibody positive for mumps IgM, and 32 were negative, although 77 were not tested. Since 1990, annual totals have never previously exceeded 20. Over 90% of patients were <20 years old, with a peak age group of 10-14 years; 88% attended schools located within Walsall. The pattern of spread suggested that the outbreak proceeded through schools from north to south in the more deprived western half of the metropolitan area. Most cases (136, 68%) had received one (99, 49.5%) or two (37, 18.5%) doses of MMR vaccine; cases > or =20 years old had never received MMR. Six cases (aged 4-14 years) were admitted to hospital, all with a successful outcome, including one male with meningitis and one female with pancreatitis. Current uptake of the MMR vaccine at 24 months has dropped to below 90% in recent years, as in most parts of the UK. CONCLUSIONS: Future mumps outbreaks in schools, and among older age groups, can be predicted, since most older children and young adults have received only one dose of MMR vaccine or no vaccination at all. Primary vaccine failure is well described in mumps, and cases during outbreaks can include recipients of two MMR vaccine doses. It was fortunate that no severe morbidity was associated with this outbreak (prior to MMR, two to four mumps deaths occurred annually in England and Wales). Measures to restore the uptake of MMR to the previous levels of above 90-95% will be necessary to reduce the risk of the mumps virus circulating within communities. Older children are susceptible, and it may be advisable to ensure second-dose MMR uptake while they are still at or when they leave school, or when they enter college, university or the military.