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Scanlon first wrote that the uptake of Measles Mumps Rubella (MMR)
vaccine may be lower than reported because of manipulation of target
groups. To this Ramsay clarified that the national uptake figures
originate from Child Health Records and not from GP list target payments.
We also have a problem with monitoring MMR uptake in our PCT. We
carried out a review of how the Child Health Systems (CHSs) work and
explored data issues. We found that the CHSs record their first entry of a
child from the birth notification; however the data on vaccination depends
on what GPs provide. Therefore, CHS data is only as good as what the
practices report, when they report it.
We have not received any complaints, internally or from the public,
and we have no reason to believe that there is any manipulation of lists
going on in GP practices in our area.
More importantly, we discovered that there was a discrepancy between
the vaccination data held by the CHS and GP practices (first dose of MMR1
(MMR1) studied as an illustrative example).
We obtained data from 27 of 37 GP practices. Nine were excluded: 6
who report their data to a different CHS; 1 conglomerate practice for whom
data extraction was too complicated; 2 practices for whom no manager could
be contacted; and 1 practice who were not willing to provide data.
We found that only 22% of the practices showed the same level of
coverage in both the practice data and the CHS data. Of the 78% of
practices whose data differed: 17% of the practices showed a decreased
coverage than what the CHS records showed; 26% of the practices showed a
higher coverage by 0 – 19%; 30% of the practices showed a higher coverage
by 20-39%; and 4% of the practices showed a higher coverage by 40-59%. A
revised analysis based on the GP practice data changed the PCT’s average
of MMR uptake from 74.9% to 85.0%. (Further details available on request.)
Under the current system practices are required to provide CHSs with
data on an on-going basis, which adds to their workload without providing
any benefit to them. This may lead to under-reporting, which would at
least partly explain the discrepancy.
Historically, CHSs have acted as prompts for flagging up children due
or overdue for vaccines but with growing financial constraints, this no
longer happens at our PCT, so the benefits of CHSs to PCTs have been
reduced. The majority of the practices reviewed expressed dissatisfaction
with the CHS method of data collection, and suggested that a system be
devised to directly access data from practices. This would not only avoid
putting unnecessary load on practices, but also provide more up-to-date
and accurate data.
One relatively simple way forward would be to request practices to
print reports directly from their systems to be sent to the CHS, where
data from all practices can be collated (rather than reactively return
individual child records when asked for by CHS). This would still require
manual re-entry of the data at the CHS, with the associated likelihood of
human error. An even better way (if technically possible) would be
electronic transfer of data between practices and the CHS. That would make
the system far more efficient, and considerably improve data quality, but
would require investment in information systems.
We cannot accurately monitor and evaluate vaccination programmes – so
vital to the health of the population – while these data issues remain
unresolved.
Competing interests:
None declared
Competing interests:
No competing interests
02 October 2006
Muzaffar A Malik
Higher Specialist Trainee in Public Health Medicine
Persistent data issues with MMR uptake
Scanlon first wrote that the uptake of Measles Mumps Rubella (MMR)
vaccine may be lower than reported because of manipulation of target
groups. To this Ramsay clarified that the national uptake figures
originate from Child Health Records and not from GP list target payments.
We also have a problem with monitoring MMR uptake in our PCT. We
carried out a review of how the Child Health Systems (CHSs) work and
explored data issues. We found that the CHSs record their first entry of a
child from the birth notification; however the data on vaccination depends
on what GPs provide. Therefore, CHS data is only as good as what the
practices report, when they report it.
We have not received any complaints, internally or from the public,
and we have no reason to believe that there is any manipulation of lists
going on in GP practices in our area.
More importantly, we discovered that there was a discrepancy between
the vaccination data held by the CHS and GP practices (first dose of MMR1
(MMR1) studied as an illustrative example).
We obtained data from 27 of 37 GP practices. Nine were excluded: 6
who report their data to a different CHS; 1 conglomerate practice for whom
data extraction was too complicated; 2 practices for whom no manager could
be contacted; and 1 practice who were not willing to provide data.
We found that only 22% of the practices showed the same level of
coverage in both the practice data and the CHS data. Of the 78% of
practices whose data differed: 17% of the practices showed a decreased
coverage than what the CHS records showed; 26% of the practices showed a
higher coverage by 0 – 19%; 30% of the practices showed a higher coverage
by 20-39%; and 4% of the practices showed a higher coverage by 40-59%. A
revised analysis based on the GP practice data changed the PCT’s average
of MMR uptake from 74.9% to 85.0%. (Further details available on request.)
Under the current system practices are required to provide CHSs with
data on an on-going basis, which adds to their workload without providing
any benefit to them. This may lead to under-reporting, which would at
least partly explain the discrepancy.
Historically, CHSs have acted as prompts for flagging up children due
or overdue for vaccines but with growing financial constraints, this no
longer happens at our PCT, so the benefits of CHSs to PCTs have been
reduced. The majority of the practices reviewed expressed dissatisfaction
with the CHS method of data collection, and suggested that a system be
devised to directly access data from practices. This would not only avoid
putting unnecessary load on practices, but also provide more up-to-date
and accurate data.
One relatively simple way forward would be to request practices to
print reports directly from their systems to be sent to the CHS, where
data from all practices can be collated (rather than reactively return
individual child records when asked for by CHS). This would still require
manual re-entry of the data at the CHS, with the associated likelihood of
human error. An even better way (if technically possible) would be
electronic transfer of data between practices and the CHS. That would make
the system far more efficient, and considerably improve data quality, but
would require investment in information systems.
We cannot accurately monitor and evaluate vaccination programmes – so
vital to the health of the population – while these data issues remain
unresolved.
Competing interests:
None declared
Competing interests: No competing interests