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Effective general practice: audit and feedback for the primary series of immunisations
Gary Reynolds1, Mareta Timo2, Anjileena Dev3
1Immunisation Advisory Centre, Conectus Centre, The University of Auckland, PB 92019, Auckland, New Zealand. dr@tfmc.co.nz.
Insights
A multifaceted audit revealed higher infant immunisation rates (95.8%) in a New Zealand general practice than national records indicated. This comprehensive audit identified gaps in vaccine delivery timeliness.
Area of Science:
- Public Health
- Immunisation Auditing
- Vaccine Delivery Systems
Background:
- General practice immunisation audits in New Zealand (NZ) often show discrepancies with national rates recorded on the National Immunisation Register (NIR).
- Accurate immunisation data is crucial for monitoring public health and ensuring vaccine coverage targets are met.
Purpose of the Study:
- To conduct a detailed audit of infant immunisations within a single general practice over 12 months.
- To compare the practice's audit findings with the NZ National Immunisation Register (NIR) data.
- To identify discrepancies and improve the accuracy of immunisation reporting.
Main Methods:
- A multifaceted audit combining manual, electronic practice management system (PMS), and NIR audit parameters for primary infant immunisations (6-week, 3-month, 5-month).
- Audits focused on the 5-month vaccination completion between February 2011 and February 2012.
- NIR database query tools were used to verify data for partially or unimmunised patients.
Main Results:
- Initial audits yielded varied results: NIR (31/36), PMS (39/43), and manual (41/48).
- The multifaceted audit identified 48 eligible infants, with 95.8% fully immunised and 4.2% partially immunised; none were unimmunised.
- Timeliness of immunisation was suboptimal, with only 52.1% of infants receiving vaccines on schedule.
Conclusions:
- The practice's actual immunisation coverage (95.8%) exceeded NIR reported rates (86.1%), surpassing NZ government and WHO targets.
- The multifaceted audit provided a more accurate estimate of eligible patients and highlighted areas for improvement in vaccine delivery processes.
Introduction:
General practice immunisation audits do not always match the national rates recorded on the New Zealand (NZ) National Immunisation Register (NIR).
Aim:
To complete audits at one general practice for infants requiring the primary series of immunisations (6-week, 3-month and 5-month vaccines) over a 12-month period and compare findings with the NIR audit.
Methods:
A manual and electronic practice management system (PMS) audit were compared with identical NIR audit parameters for completion of the 5-month vaccination from 1 February 2011 to 1 February 2012. All three results were then combined with further sub-audits of the total practice newborn population to produce a multifaceted audit, identifying further eligible patients. The NIR database query tool was used to corroborate data on partially immunised and unimmunised patients identified.
Results:
All three initial audits produced different results for vaccinated and eligible patients: NIR 31/36; PMS audit 39/43; manual audit 41/48. The multifaceted audit identified 48 eligible infants. All 48 (100%) started their primary series-95.8% (46 of 48) fully immunised; 4.2% (2 of 48) partially immunised, missing only one injection. None were unimmunised, contrary to initial audits. Lower levels of timeliness of delivery were confirmed for this practice, with 52.1% (25 of 48) immunised on time.
Discussion:
Results show 9.7% higher levels of immunisation than reported by NIR statistics for this practice (95.8% vs 86.1%), above current NZ government and World Health Organization targets. The multifaceted audit produced the best estimate of eligible patients and identified deficiencies in vaccine delivery.
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