| Title:
|
Delivering routine immunisations in London during the COVID-19 pandemic: lessons for future vaccine delivery. A mixed-methods study |
| Abstract:
|
BACKGROUND: General practices in England have continued to care for patients throughout the COVID-19 pandemic by instigating major changes to service delivery. Immunisations have continued although the number of vaccines delivered initially dropped in April 2020. AIM: To evaluate how COVID-19 impacted the delivery of immunisations in London and identify innovative practices to inform future delivery including for COVID-19 vaccines. DESIGN & SETTING: A mixed-methods study of immunisation delivery in London UK. METHOD: An online survey of London general practices was undertaken in May 2020 to produce a descriptive analysis of childhood immunisation delivery and identify innovative delivery models. Semi-structured interviews were conducted between August and November 2020 to explore innovative immunisation models which were analysed thematically. RESULTS: Sixty-eight per cent (n = 830) of London practices completed the survey and 97% reported having continued childhood immunisation delivery. Common delivery adaptations included spaced-out appointments calling parents beforehand and having only one parent attend. Forty-three practices were identified as having innovative models such as delivering immunisations outside practice buildings or offering drive-through services. The thematic analysis of 14 semi-structured interviews found that alongside adaptations to immunisation delivery within practices existing local networks collaborated to establish new immunisation delivery models. Local population characteristics affected delivery and provide insights for large-scale vaccine deployment. CONCLUSION: Immunisations continued during 2020 with practices adapting existing services. New delivery models were developed by building on existing local knowledge experiences and networks. Immunisation delivery during the pandemic including for COVID-19 vaccines should be tailored to local population needs by building on primary care immunisation expertise. |
| Published:
|
2021-06-23 |
| Journal:
|
BJGP open |
| DOI:
|
10.3399/bjgpo.2021.0021 |
| DOI_URL:
|
http://doi.org/10.3399/bjgpo.2021.0021 |
| Author Name:
|
Skirrow Helen |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/skirrow_helen |
| Author Name:
|
Flynn Charlotte |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/flynn_charlotte |
| Author Name:
|
Heller Abigail |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/heller_abigail |
| Author Name:
|
Heffernan Catherine |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/heffernan_catherine |
| Author Name:
|
Mounier Jack Sandra |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/mounier_jack_sandra |
| Author Name:
|
Chantler Tracey |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/chantler_tracey |
| sha:
|
57977df49db35a5d0c3ba70ee5c38226e8886478 |
| license:
|
cc-by |
| license_url:
|
https://creativecommons.org/licenses/by/4.0/ |
| source_x:
|
Medline; PMC; WHO |
| source_x_url:
|
https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/https://www.who.int/ |
| pubmed_id:
|
34006529 |
| pubmed_id_url:
|
https://www.ncbi.nlm.nih.gov/pubmed/34006529 |
| pmcid:
|
PMC8450879 |
| pmcid_url:
|
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450879 |
| url:
|
https://www.ncbi.nlm.nih.gov/pubmed/34006529/
https://doi.org/10.3399/bjgpo.2021.0021 |
| has_full_text:
|
TRUE |
| Keywords Extracted from Text Content:
|
networks
COVID-19 vaccines
spaced-out
COVID-19
patients
Immunisations
UK
London general
NHS
ImmForm
COVID-19
COVID-safe
walkin
A/H1N1
Rubella
PCN
UK
pre-book
...
Mumps
children
London (see Table 1
green
NHS England/
COVID-19 vaccines
TC
[Interview 13]
People
PHE
participants
NHS England/Improvement
NR0218
SMJ
NHSE
infants
H1N1 influenza vaccine
waiting-room
East London
PCNs
COVID-19 vaccine
line
Measles
HS
CCGs
people
patient
portal
care networks
spaced-out
Supplementary Box S1
CCG representatives
CF
cold-hub
CCG
patients
hubs non-COVID-19
Patients
PPE
lockdown
human
GP federations
hepatitis B
NHS |
| Extracted Text Content in Record:
|
First 5000 Characters:Background: General practices in England have continued to care for patients throughout the COVID-19 pandemic by instigating major changes to service delivery. Immunisations have continued, although the number of vaccines delivered initially dropped in April 2020.
Aim: To evaluate how COVID-19 impacted the delivery of immunisations in London and identify innovative practices to inform future delivery, including for COVID-19 vaccines.
Design & setting: A mixed-methods study of immunisation delivery in London, UK.
Method: An online survey of London general practices was undertaken in May 2020 to produce a descriptive analysis of childhood immunisation delivery and identify innovative delivery models. Semistructured interviews were conducted between August and November 2020 to explore innovative immunisation models, which were analysed thematically.
Results: Sixty-eight per cent (n = 830) of London practices completed the survey and 97% reported having continued childhood immunisation delivery. Common delivery adaptations included spaced-out appointments, calling parents beforehand, and having only one parent attend. Forty-three practices were identified as having innovative models, such as delivering immunisations outside practice buildings or offering drive-through services. The thematic analysis of 14 semi-structured interviews found that, alongside adaptations to immunisation delivery within practices, existing local networks collaborated to establish new immunisation delivery models. Local population characteristics affected delivery and provide insights for large-scale vaccine deployment.
Conclusion: Immunisations continued during 2020 with practices adapting existing services. New delivery models were developed by building on existing local knowledge, experiences, and networks. Immunisation delivery during the pandemic, including for COVID-19 vaccines, should be tailored to local population needs by building on primary care immunisation expertise.
Although the number of vaccines delivered initially decreased in April 2020, general practices in England continued providing immunisations during the 2020 COVID-19 pandemic. This study found that general practices across London continued to provide immunisations by making adaptations Skirrow H et al.
to how they were delivered within practices. Some general practices introduced innovative delivery models such as immunisations being given outside or via mass drive-through services. Innovative immunisation delivery was based on general practices' existing local networks and expertise, which may support the implementation of other immunisation programmes such as COVID-19 vaccination.
The COVID-19 pandemic affected the delivery of immunisation programmes globally. [1] [2] [3] As of May 2020, the World Health Organization found that 75% of countries surveyed were experiencing disruptions to immunisation programmes owing to Immediately following the implementation of the national lockdown in March 2020, the number of routine Measles, Mumps, and Rubella (MMR) vaccinations delivered decreased by 19 .8% in England, 1 before recovering over the following months. 5, 6 This disruption is likely to have arisen from both barriers to normal delivery within practices and confusion among patients about the availability of health services. Barriers within practices may have included the need to implement social distancing and adhere to infection prevention procedures, securing appropriate personal protective equipment (PPE), as well as staff availability and capacity. Patients may not have attended practices because they feared contracting COVID-19, faced transport barriers, or because of shielding and/or isolation requirements. 7 It has been reported that parents were confused about whether scheduled immunisations were operating as usual 8 and the government recommendation to 'stay at home' may have been interpreted as not needing to attend for immunisation appointments. 9 International and national guidance was clear that routine immunisation services should continue during the COVID-19 pandemic and general practices in England were directed to prioritise the childhood immunisation programme, pertussis vaccination in pregnancy, hepatitis B vaccination to at-risk infants, and pneumococcal vaccination in at-risk groups. [10] [11] [12] To continue delivering essential services, general practices had to make rapid changes to how care was delivered, 13 including adaptations to routine immunisation delivery. 14 Some innovative immunisation delivery, such as a practice in East London that offered a drivethrough immunisation service, has been described. 15, 16 However, there is a lack of literature reporting on innovative immunisation delivery during the COVID-19 pandemic. First, this study aimed to understand how general practices in London adapted their delivery of routine childhood immunisations to maintain population protection against vaccine preventable diseases during the COV |
| Keywords Extracted from PMC Text:
|
waiting-room
usual8
people
Belgium27
line
COVID-19
COVID-19 vaccine
Patients
pre-book
US26
human
CF
lockdown
NHS England/Improvement
A/H1N1
CCG representatives
GP federations
COVID-safe
children
described.15,16
patient
H1N1 influenza vaccine
Rubella
infants
spaced-out
cold-hub
's
TC
NHSE
structures'.38
patients
hepatitis B
Supplementary Box S2) —
Measles
...
networks
England,1
[Interview 13]
portal
PCN
Supplementary Box S1
People
CCGs
ImmForm
groups.10–12
PCNs
COVID-19 vaccines
care networks
...'
months.5,6
CCG
PPE
lockdown,1
HS
pandemic,13,14,25
General Practitioner's
Mumps
COVID-19 vaccines —
exploration.18
PCNs.36,37
PHE
SMJ
themes.20
NHS
UK |
| Extracted PMC Text Content in Record:
|
First 5000 Characters:Although the number of vaccines delivered initially decreased in April 2020, general practices in England continued providing immunisations during the 2020 COVID-19 pandemic. This study found that general practices across London continued to provide immunisations by making adaptations to how they were delivered within practices. Some general practices introduced innovative delivery models such as immunisations being given outside or via mass drive-through services. Innovative immunisation delivery was based on general practices' existing local networks and expertise, which may support the implementation of other immunisation programmes such as COVID-19 vaccination.
The COVID-19 pandemic affected the delivery of immunisation programmes globally.1–3 As of May 2020, the World Health Organization found that 75% of countries surveyed were experiencing disruptions to immunisation programmes owing to COVID-19.4 Immediately following the implementation of the national lockdown in March 2020, the number of routine Measles, Mumps, and Rubella (MMR) vaccinations delivered decreased by 19.8% in England,1 before recovering over the following months.5,6 This disruption is likely to have arisen from both barriers to normal delivery within practices and confusion among patients about the availability of health services. Barriers within practices may have included the need to implement social distancing and adhere to infection prevention procedures, securing appropriate personal protective equipment (PPE), as well as staff availability and capacity. Patients may not have attended practices because they feared contracting COVID-19, faced transport barriers, or because of shielding and/or isolation requirements.7 It has been reported that parents were confused about whether scheduled immunisations were operating as usual8 and the government recommendation to 'stay at home' may have been interpreted as not needing to attend for immunisation appointments.9
International and national guidance was clear that routine immunisation services should continue during the COVID-19 pandemic and general practices in England were directed to prioritise the childhood immunisation programme, pertussis vaccination in pregnancy, hepatitis B vaccination to at-risk infants, and pneumococcal vaccination in at-risk groups.10–12 To continue delivering essential services, general practices had to make rapid changes to how care was delivered,13 including adaptations to routine immunisation delivery.14
Some innovative immunisation delivery, such as a practice in East London that offered a drive-through immunisation service, has been described.15,16 However, there is a lack of literature reporting on innovative immunisation delivery during the COVID-19 pandemic. First, this study aimed to understand how general practices in London adapted their delivery of routine childhood immunisations to maintain population protection against vaccine preventable diseases during the COVID-19 pandemic. Second, the study examined how practice adaptations and innovative delivery models could support future routine immunisation services, including COVID-19 vaccination programmes.17
An online questionnaire was developed and emailed to all 1215 London practices via a Public Health England Select Survey link on the 28 April 2020. The questionnaire consisted of six questions and asked practices whether they had delivered childhood (0–5 years) immunisations in the last 7 days, the adaptations they had made to their delivery of childhood immunisations, and what support they needed to continue to be able to vaccinate their eligible 0–5 years population (Supplementary Box S1). Practices were asked to complete the questionnaire by 29 May 2020. All practices were sent a reminder email a week before this final deadline. Contact with the practices was facilitated by the NHS England/Improvement (London Region) Immunisation Commissioning Team, who also emailed reminders to the clinical commissioning group (CCG) areas with lower response rates before the deadline.
Questionnaire data were exported from the Public Health England (PHE) select survey portal into Microsoft Excel for analysis. A descriptive analysis of the survey in Excel was considered appropriate to identify case studies for further exploration.18 Duplicate responses were removed, and responses coded into categorical and continuous variables, in accordance with an agreed codebook. The open-ended questions on how immunisations were being delivered and the support they needed were post-coded into nominal variables. Two researchers (HS and CH) independently identified response categories and compared findings. Frequency and percentage distributions were used to summarise survey responses. Forty-three practices were identified as having innovative models of immunisation delivery.
The purpose of the interviews was to examine the adaptations and new immunisation delivery models developed by practices. In the sampling adaptatio |
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