| Research backgroundVaccination is the most economical and effective measure in the prevention and control of specific infectious diseases or eradication of them. Vaccination development up to now, in China it has become an act of government.It’s regulations and policis are very comprehensive. Laws, regulations, norms such as "Infectious Diseases Prevention Law","Vaccine Circulation and Vaccination Regulations","Adverse Events Following Immunization Identification Approach","National Adverse Events Following Immunization Monitoring Program ","On the issuance of the notice of<Shanghai vaccination unit management approach>,<Shanghai vaccination clinics work specification＞", have made clear provisions for the vaccination work.Since2003, Pudong New Area household registration children’s reported vaccination rates of free vaccines have remained above99%. Migrant children’s reported vaccination rates of free vaccines also have risen quickly to this level.The immunization amount has increased rapidly from more than800000in2004to more than1800000in2011. Since2005, Pudong New Area’s free vaccines preventable infectious diseases,such as poliomyelitis, diphtheria, tetanus of newborn, are without the cases. And the incidence rates of pertussis, meningitis, encephalitis are lower than0.1/100000respectively. The incidence rates of acute hepatitis B, measles decreased obviously. Rubella incidence rate was significantly lower than the national level of the same period. However, the incidence of mumps that the MMR vaccine can prevent was significantly higher than the national level of the same period. It should do the further research.In addition, although varicella can be prevented by charge vaccine, Pudong New Area’s varicella incidence was from41.55/100000in2005up to the75.23/100000in2011.It should search corresponding countermeasure.Pudong New Area is the major population lead-in area and floating population agglomeration areas of Shanghai.In recent years, along with the development of the family economic level and immune prevention knowledge level, continuously improve the willingness of residents to vaccinate children.So, as the leading provider of vaccination service, the community vaccination clinics’workload is increasing with an average annual growth rate as high as8.85%,what conflict with the staff shortage, poor conditions of software and hardware. In addition, the staffs discontent what were made due to increased workload, the technical requirements to improve, but the improvement in wages, work acceptable levels, work environment is lagging behind has embodied,what may affect the service level. Therefore, study of vaccination clinic physician satisfaction to improve service quality has important significance. In addition, the understanding of parents’satisfaction of clinic hardware and service, parental vaccination knowledge and attitude also can provide reference to adopt pertinent measures to improve community clinic service.Study objectiveThrough the study, we can understand Pudong New Area vaccination clinic service status, software and hardware configuration, vaccination coverage and target disease incidence and distribution, adverse events following immunization monitoring status, clinic staff satisfaction and demand, service objects’awareness rate of immunity knowledge and satisfaction, find the existing problems, explore the measures to improve the deficiency of EPI and to further improve the level of service.Data sources and methods1. Though study of Pudong New Area Center for Disease Control and prevention’s historical routine vaccination registration system data, descriptively analyze community vaccination clinic service, vaccination workload, immunization coverage rate, reported incidence of AEFI, incidence and distribution characteristics of immune preventable infectious disease.2. Though sampling survey of1567children’s parents by self-administered questionnaire, investigate the vaccination knowledge and satisfaction of vaccination clinic service.3. Though sampling survey of165staffs of community vaccination clinics by the self-administered questionnaire, investigate the demand and satisfaction of work environment, strength, salary, occupation development. Main findings and results1. Study of Pudong New Area community vaccination clinic service status (1) Pudong New Area has48community vaccination clinics,which average service area is25.66km2and service5.23times per week. The district group average serves6.57times per week, and the town group4.68.(2) Clinic staffs increasing each year, the average annual increase is2.87%. The business area is increased by7.37%per year. Clinic standardization construction condition gradually improved, comparison the standard of town group with the district group, the town group was better than the district group..(3) Pudong New Area resident population increased with the annual growth rate of4.46%. Children aged0-6which were served as the main group grew with the annual rate of9.56%, especially migrant children’s annual growth rate as high as15.24%.(4) The average annual growth rate of Pudong New Area vaccination quantity was amounted to9.84%, and that of the community clinic annual average growth rate was8.85%. Since2007, floating children vaccinated more than the local children. The free vaccine reported vaccination rates of Pudong New Area are above99%, consistent with the findings of five vaccine vaccination rate survey.(5)2005-2011, Pudong New Area found no polio cases, diphtheria cases, pertussis neonatal cases, and only1pertussis cases had occurred.The morbidity of meningitis or encephalitis was minimal. Acute hepatitis B incidence was from10.44/100000down to5.68/100000, measles incidence from8.84/100000down to0.35/100000. Rubella incidence was significantly lower than the national level of the same period. But mumps incidence rate was significantly higher than the national level of the same period, and varicella epidemic incidence shew clear ascendant trend.(6) The onset of diseases most is varicella, accounted for65.42%, followed by the mumps, accounted for19.29%, third hepatitis B,9.51%. The onset most was in children aged0-14years. From the occupation, the highest incidence is students, followed by kindergarten children. The sex ratio was1.58:1. The peak incidence is the second quarter and fourth quarter, accounting for total cases number60.09%.2. Monitoring and analysis of adverse events following immunization of Pudong New Area,2008-2011(1)2008-2011, Pudong New Area reported a total of4255patients with AEFI. The average reported rate is52.32/100000.(2) Sex ratio was1.46:1,≤6years old accounted for92.60%,7-16years old accounted for5.92%,≥17years old accounted for1.48%.The AEFI report rate presents a high rate in high temperature season and low rate in cold season.(3) AEFI happened on the day of vaccination was58.90%, after1-7d accounted for39.18%. AEFI found by the system, the interval<1d was60.99%,1-7d30.18%.(4) Fever, local swelling and induration what were the main symptoms accounted for94.29%. In the outcomes, cure accounted for85.50%, improved13.84%, sequelae0.14%,0.05%death due to other diseases are coupling,0.47%unknown.3. Pudong New Area community vaccination clinic staff satisfaction(1) In165subjects, the median age was34, median length of service3years. (2) Great intensity accounted for43.6%, stronger intensity42.4%, that work intensity of general or not strong only13.9%. Feeling very tired accounted for57.6%, some fatigue41.8%, not fatigue0.6%.(3) The survey of the most important issues in the work is low-income, followed by poor working environment.(4) The doctors’ average satisfaction score were7.57±1.99points. Logistic regression analysis the three variables which are the job satisfaction, work environment and leadership recognization are the fators what can affect the satisfaction.4. Pudong New Area children’s parents’ vaccination satisfaction(1) The pathways of children’s parents get vaccination knowledge selected mostly were homes physicians, community physicians, television broadcast. The questions of vaccination knowledge were answered correctly by over90%parents.(2)90.62%of the parents believed that vaccination clinic is convenient, and53.35%of parents thought the clinic environment good, and45.82%of parents thought the waiting time was too long.30.89%of parents did not pay much attention to the clinic’s propaganda layout.(3) Parents are most concerned about the waiting time, the reasonableness of the vaccination process, doctors’ vaccination technique, the proportion were24.63%,19.97%,19.91%。(4) The parents overall score vaccination clinics with an average of8.02points.Conclusions1. Continue to accelerate the growth of clinic standardized construction, but still can’t follow the service object growth. The staff increased by2.87%, and the clinic area increased by7.37%. Pudong New Area resident population growth rate of4.46%, of which0-6years old children’s annual growth rate of9.56%, especially the migrant children’s annual growth rate as high as15.24%, which led to the personnel and the outpatient area increases far less than inoculation amount of the rapidly average annual increase of8.85%.2. Inoculation amount continued to increase, vaccination rates remain high. During2004-2011, Pudong New Area completed a total of13024372doses of vaccination, the average annual growth rate of9.84%, in which the community vaccination clinic completed inoculation agent11265213times, average annual growth rate of8.85%. The free vaccine rates reported above99%.3. The immunization preventable infectious diseases are basically under control, and individual incidence of disease are on the rise.2005-2011, Pudong New Area found no polio cases, diphtheria cases, pertussis neonatal cases, and only1pertussis cases had occurred.The morbidity of meningitis or encephalitis was minimal, lower than0.1/100000.The incidence of acute hepatitis B and measles reduced quickly. Rubella incidence was significantly lower than the national level of the same period. But mumps incidence rate was significantly higher than the national level of the same period, varicella epidemic incidence shew clear ascendant trend.4. Part of the immune preventable infectious diseases had obvious features. The onset of immune preventable infectious diseases most is varicella, followed by the mumps, third hepatitis B. The onset most was in children aged0-14years. From the occupation, the highest incidence was students, followed by kindergarten children. The peak incidence is the second quarter and fourth quarter.5. AEFI report incidence is high. The2008-2011report incidence of AEFI of Pudong New Area was52.32/100000, far higher than other areas in China recent findings, and the AEFI report incidence is stable.6. AEFI was featured by fever and minor local reactions,and the AEFI report incidence of bacterial vaccines was high. Fever, local local reactions what were AEFI main symptoms accounted for94.29%. The report incidence of virus vaccine, bacterial vaccine, non-vaccine products, viruses and bacteria combined vaccine was23.84/100000,112.54/100000,0.00/100000,330.25/100000.AEFI report incidence of bacteria vaccine is higher than that of viral vaccine and non-vaccine products.7. AEFI report incidence of vaccination clinics were not evenly distributed.That prompted that the AEFI report incidence were affected by the monitoring awareness of different vaccination clinics staff.8. AEFI monitoring mode needs to be improved. There is a big gap between the monitoring AEFI incidence and clinical findings. But mainly by actively monitoring, the AEFI report incidences of the newly listing using vaccines, DPT-Hib and DPT-IPV-Hib, were571.76/100000and330.25/100000, which suggested the gap could be narrowed.9. The outpatient staffs are general lower academic qualifications, lower titles. length of service not long.10. The clinic staff overall satisfaction score is not high.The staff average satisfaction score7.57±1.99points.Vaccination clinic medical staff generally agreed the intensity of the work, fatigue. Higher satisfaction in the relationship between colleagues, the ability to play, reached87.88%,76.97%, respectively. The most dissatisfied was the working conditions with the rate of49.09%.11. The job satisfaction, work environment, leadership recognition were the main factors of staff satisfaction. Because of differences of the job expectation and job actual, easily lead to unsatisfactory. Secondly, the most outpatient doctors are not satisfied with the present level of income that does not reflect the value of labor and technical level, less than other positions in the same unit income, failed to reflect the recognition of the leadership of the work. In addition, immunization program is a long-term accumulation of a lot of work to gradually pay off the work easily lead to the outpatient doctor accomplishment not strong. There were somewhat neglected of staff working environment.12. Basically met the parents of the availability and demand for immunization services. Parents could reach the vaccination clinics in an average of19minutes.Most parents thought that the environment of clinic was good, and higher satisfaction with the staff service attitude, vaccination technique and process, which overall reflected the location and configuration of the outpatient basically met the parents of the availability and demand for immunization services.13. Parents master the general vaccination knowledge better. The inoculation knowledge questions were answered correctly by over90%parents. For general adverse reactions after vaccination, the majority parents knew how to do. Almost all the parents were willing to cooperate with the doctor on a regular basis to the children vaccination.14. Clinics run and parents cognition still exist some problems.(1) The average queuing time is29.1minutes,45.82%of the parents think that is too long.(2)30.89%of parents never pay attention to the propaganda layouts posted in the vaccination clinics.Recommendations1. Strengthen clinic standardized construction. Health administrative departments should be appropriate to deploy the regional health resources, increase staffs and the funds, strengthen the supervisory work.Community health service centers should increase the staffs involved in vaccination, speed up the clinic reconstruction and add clinic open times to provide quality vaccination services for the majority of residents.2. Strengthen clinic information technology construction. The clinic information construction should be strengthened urgently. Vaccination clinics without the information system should be as soon as possible to improve the hardware facilities and equipment, enhance system operation training of staff, and use of information systems as soon as possible.3. Take specific measures to prevent and control of major infectious diseases.Based on the incidence of infectious disease characterized, in the next we should take the following measures:(1) community vaccination clinics should be focus on MMR vaccination and reasonably recommend varicella vaccine to promote mumps and chicken poxepidemic prevention and control;(2) in accordance with the different seasons,do a good job on prevention and control immune preventable infectious diseases, and focus on students and kindergarten children;(3) The prevention and control of the household registration children and the residents of district who have the better health conditions in general concept also can not be ignored.4. Strengthen the training and supervisor of the AEFI monitoring to improve the awareness of staff monitoring. By strengthening the training of community vaccination clinic staff and medical staff, improve AEFI monitoring consciousness. At the same time, improve AEFI monitoring evaluation approach to further promote the monitoring.5. Implement the AEFI proactive monitoring mode, and improve monitoring sensitivity. Further explore the effective the AEFI proactive monitoring mode and to promote in order to ensure vaccine safety monitoring sensitivity and reflect the actual occurrence of AEFI, more objective reflect adverse reactions after vaccination status.6. Improve the the clinic occupational environment, and improve staff income. Establish an appropriate workload, low-noise occupational environment. By appropriate increase in benefits, proper moral encouragement or material rewards, reward doctors work to increase their sense of accomplishment and recognition.7. Reasonably arrange the post, and make good career planning.From the perspective of developing ability, having right and realization of self value, arrange clinic jobs reasonably, plan the career development of staff, mobilize the enthusiasm of the medical staff, and enhance the cohesion of the team. So they really become the main force to promote the comprehensive development of community health services.8. Improve the form of propaganda. Change the current mainly propaganda mode that was posting propaganda layout, and take the form of propaganda the residents love to see and hear, such as the issuance of "immune planning knowledge quiz" booklet, screening knowledge video, to raise parents’immune core knowledge and information awareness. |
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