Vaccination in England: a review of why business as usual is not enough to maintain coverage.

摘要: The vaccine system in England underwent radical changes 2013 following the implementation of Health and Social Care Act. There have since been multi-year decreases coverage many vaccines. Healthcare professionals reported finding new fragmented challenging. This study aims to produce a logic model evaluate available evidence for interventions improve coverage. We undertook qualitative document analysis develop using process evaluation methods. performed systematic review by searching 12 databases with broad search strategy identify studied conducted between 2006 2016 evaluated their effectiveness. then compared base model. analysed 83 documents developed describing core inputs, processes, activities, outputs, outcomes impacts vaccination alongside programmatic assumptions each stage. Of 9,615 unique articles, we screened 624 abstracts, 45 full-text included 16 studies: 8 randomised controlled trials quasi-experimental studies. Four studies suggest that modifications contracting incentive systems can increase coverage, but other programme inputs (e.g. human or capital resources) were not evaluated. multi-component intervention modified activities outputs from within GP practice part campaigns projects. Thus, potentially modifiable factors relating routine remain unexplored. Reminder/recall are under-studied England; payments adolescents may be effective; only two carer information. immunisation limited small number significant risk bias. Several areas important primary care unexplored as targets interventions, especially modification organisational management.