We are all acutely aware of the declining immunisation rates in New Zealand, and across the globe. The impacts of this are clear and highlighted in our national press.
Our DHBs are all under pressure to show they are doing everything they can to meet the targets set by the Ministry of Health. With the falling rates the DHB's are seeking our support to try and turn the tide.
How is your locality going? The following graphs show the immunisation coverage of children at 6 months and 8 months enrolled with Pinnacle practices in each DHB area.
The purple and green lines are the ones to concentrate on, these show the level of immunisation at 8 months. (The blue and red lines show achievement at six months and are an indication of the challenges coming over the next two months.)
The picture for Lakes DHB region looks the worst and we have looked at whether this was a data collection issue, but unfortunately it's not.
It is important to note no area is doing well and in the words of a DHB staff member "we are losing herd immunity".
I know this is a daily concern for Pinnacle members, and that it is not a new problem.
I firmly believe practices are already doing everything possible to make sure immunisations are provided to those who accept them. I know you do everything you can to get alongside your patient and explain the pros and cons of immunisation.
I know you are non-judgmental and address every whānau's concerns individually. I know you are aware of the very limited exclusions for an immunisation and that you never turn a child away just because they have a cold.
I know you review the rate of immunisation uptake for your practice and make this a priority at your morning huddles and clinical meetings.
I know it all takes time; the "pre-calls", "recalls" and reacting to patient prompts. Anyone who works in general practice knows that sometimes it just feels too hard to take on the conversation. Building trust and a relationship slowly will sometimes help whānau to make the right decision.
The IMAC website has advice relevant to the challenges being presented - the family that don't trust the medical profession at all, the family that think immunisation causes harm, the family that believe in "natural immunisation".
For those who respond to less formal information you may want to check out how this USA based paediatrician does it.
Or you may be interested to take a look at the TED talk collection on immunisations.
To help identify the scale of the problem 'at the coalface' I have put together a matrix. I hope your clinical team can take a little time to complete it by looking at your list of unimmunised children and considering what may have led to that decision. The aim is to feedback to the DHB's the numbers of people in each category in the matrix, as evidence suggests each group will respond to different approaches and support.
It would be great if you could sit down with your team and look at your patient list. Consider all those who are "non-immunised" or only partially immunised as well as those who are currently late for immunisations. Where do they fit in this matrix?
a good idea of numbers we'll be better informed to discuss with our DHBs how
much effort needs to be put into outreach immunisation and extended access
opportunities, how much to put into incentive programmes or personal education
and connections, and how much needs to be put into the public health messaging
to try and develop peer opinion change.
You can also use the "delay/decline" matrix to consider approaches to your population. We're hearing the most difficult issue for practices now is not those who delay out of ignorance or chaotic lifestyles, but instead the growing numbers of people whose mindset is antagonist to immunisation. Some of this group may respond to expert persuasion, but most need to see a change in their peer group attitudes and behaviours.
We are hoping you will be prepared to share the number of patients that fit in each category with us so we can tailor a network wide response to DHBs. For example, if we know how many people fit in the "frozen chicken/grocery voucher box" we may be able to persuade the DHBs to help with that, but more importantly we need to know how many people in your practice are in the confrontation/Facebook/peer group box. These are "the never have, never wills" determined decliners who our public health colleagues need to be more aware of.
I am keen to hear from practice staff with ideas for anything more Pinnacle or the DHBs could do to help improve immunisation rates in our districts. Email me on firstname.lastname@example.org, or let your practice support person know.