Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Outreach immunisation services in New Zealand: a review of service delivery models

Loretta Roberts 1 , Nikki Turner 1 , Barbara McArdle 1 , Mary Nowlan 1 , Lynn Taylor 1 , Rachel Webber 2 , Paul Rouse 3
+ Author Affliations
- Author Affliations

1 Immunisation Advisory Centre, Department of General Practice and Primary Health Care, The University of Auckland, New Zealand

2 National Immunisation Programme, Ministry of Health, New Zealand

3 Department of Accounting and Finance, The University of Auckland, New Zealand

Correspondence to: Mary Nowlan, Immunisation Advisory Centre, Private Bag 92019, Auckland 1142, New Zealand. Email: m.nowlan@auckland.ac.nz

Journal of Primary Health Care 9(1) 62-68 https://doi.org/10.1071/HC16012
Published: 17 February 2017

Journal Compilation © Royal New Zealand College of General Practitioners 2017.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Abstract

INTRODUCTION: Outreach Immunisation Services (OIS) enable children who have not been immunised on time at general practice to be immunised in the community, thereby improving immunisation coverage and reducing equity gaps.

AIM: To identify the most effective service delivery models and make recommendations for more effective and cost-efficient OIS delivery in New Zealand.

METHODS: Data collection and thematic analysis through a detailed review of OIS contracts and service specifications, an online survey and in-depth interviews with stakeholders and providers, and an analysis of cost data was conducted.

RESULTS: In total, 28 OIS providers completed survey questionnaires, 28 OIS staff were interviewed, and cost effectiveness data were obtained from 11 providers. The surveys and interviews identified key themes around identifying clients with the highest needs, effective engagement strategies, staffing requirements, and service challenges. On average, each OIS referral costs NZ$361 (median NZ$257), and each vaccination event costs NZ$636, ranging from NZ$145 to NZ$2403. Characteristics for two separate models of service delivery were identified based on provider size.

CONCLUSION: There is considerable range in costs and style of OIS delivery, and efficiencies can be gained. Models need to fit with locality needs and include adequate resourcing, staff with good local knowledge, close relationships with other key child health services and preferably co-location, sustainable funding, and regular service reviews. OIS are part of an effective integrated service that relies on accurate data, positive relationships and a rapid response when children fail to present for vaccination in a timely fashion.

KEYWORDS: Immunisation; vaccination; primary health care; family health care; equity


References

[1]  Turner N. The challenge of improving immunization coverage: the New Zealand example. Expert Rev Vaccines. 2012; 11 9–11.
The challenge of improving immunization coverage: the New Zealand example.CrossRef | open url image1

[2]  Andrews B, Simmons P, Long I, et al. Identifying and overcoming the barriers to Aboriginal access to general practitioner services in Rural New South Wales. Aust J Rural Health. 2002; 10 196–201.
Identifying and overcoming the barriers to Aboriginal access to general practitioner services in Rural New South Wales.CrossRef | open url image1

[3]  Bates AS, Fitzgerald JF, Dittus RS, et al. Risk factors for underimmunization in poor urban infants. JAMA. 1994; 272 1105–10.
Risk factors for underimmunization in poor urban infants.CrossRef | 1:STN:280:DyaK2M%2FhvVyqtA%3D%3D&md5=5b30677b33d18d26056fbb32c31b49c4CAS | open url image1

[4]  Petousis-Harris H, Goodyear-Smith F, Godinet S, et al. Barriers to childhood immunisation among New Zealand mothers. N Z Fam Physician. 2002; 29 396–401. open url image1

[5]  Grant CC, Turner N, Jones R. Eliminating ethnic disparities in health through immunisation: New Zealand’s chance to earn global respect. N Z Med J. 2009; 122 6–9. open url image1

[6]  Drezner K, Newbern EC, Ossa A, et al. Evaluation of a community immunization outreach program–Philadelphia, Pennsylvania. J Public Health Manag Pract. 2015; 21 263–8.
Evaluation of a community immunization outreach program–Philadelphia, Pennsylvania.CrossRef | open url image1

[7]  Ministry of Health. National and DHB immunisation data 2015 [updated 2016 Aug 1; accessed 2015 Sept 21]. Available from: www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data

[8]  Ministry of Health. Immunisation coverage 2015 [updated 08 Jul 2013; accessed 2015 Dec 1]. Available from: www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage

[9]  Bosch-Capblanch X, Banerjee K, Burton A. Unvaccinated children in years of increasing coverage: how many and who are they? Evidence from 96 low-and middle-income countries. Trop Med Int Health. 2012; 17 697–710.
Unvaccinated children in years of increasing coverage: how many and who are they? Evidence from 96 low-and middle-income countries.CrossRef | open url image1

[10]  Williams IT, Milton JD, Farrell JB, et al. Interaction of socioeconomic-status and provider practices as predictors of immunization coverage in Virginia children. Pediatrics. 1995; 96 439–46.
| 1:STN:280:DyaK2MzotVahsQ%3D%3D&md5=66cb6ff159aeca6426511d9f06a25980CAS | open url image1

[11]  Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med. 2000; 18 97–140.
Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults.CrossRef | 1:STN:280:DC%2BD3c3msFalsA%3D%3D&md5=3b2a88061d9f819bede6bfa5fb26b80bCAS | open url image1

[12]  Hambidge SJ, Phibbs SL, Chandramouli V, et al. A stepped intervention increases well-child care and immunization rates in a disadvantaged population. Pediatrics. 2009; 124 455–64.
A stepped intervention increases well-child care and immunization rates in a disadvantaged population.CrossRef | open url image1

[13]  Ivers N, Jamtvedt G, Flottorp S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012; 6 1–227. open url image1

[14]  Lewin S, Lavis JN, Oxman AD, et al. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet. 2008; 372 928–39.
Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews.CrossRef | open url image1

[15]  Roberts JR, Freeland KD, Kolasa MS, et al. Do immunisation procedures match provider perception? A study from the South Carolina Pediatric Practice Research Network (SCPPRN). Qual Prim Care. 2011; 19 147–54. open url image1

[16]  Fu LY, Zook K, Gingold J, et al. Frequent vaccination missed opportunities at primary care encounters contribute to underimmunization. J Pediatr. 2015; 166 412–7.
Frequent vaccination missed opportunities at primary care encounters contribute to underimmunization.CrossRef | open url image1

[17]  Turner N, Grant C, Goodyear-Smith F, et al. Seize the moments: missed opportunities to immunize at the family practice level. Fam Pract. 2009; 26 275–8.
Seize the moments: missed opportunities to immunize at the family practice level.CrossRef | open url image1


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