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Journal of Public Health Advance Access published online on July 4, 2006
Journal of Public Health, doi:10.1093/pubmed/fdl017
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© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Article

The QOF equity window: an illusion or a different view?

Karen Noakes 1, Richard G. Pebody 2 *, Usha Gungabissoon 2, Julia Stowe 2, and Elizabeth Miller 2

1 Immunisation Policy, Monitoring and Surveillance, Department of Health, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
2 Immunisation Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK

* To whom correspondence should be addressed.
Richard G. Pebody, E-mail: richard.pebody{at}hpa.org.uk


  Abstract

Objective Following the licensure of 23-valent pneumococcal polysaccharide vaccine (23vPPV) in 1989, a risk-group-only immunization policy was implemented in 1992 in England. The PPV programme was extended in 2003 to include all individuals 65 years and over. In England, this was phased in over 3 years. To ascertain the performance of the risk group policy in those 65 years of age and over and provide a baseline to estimate the impact of the universal elderly programme.

Methods Information was gathered on vaccine uptake for the period 1989-2003 in England from a national survey of general practitioners (GPs) through NHS primary care trusts (PCTs), the prescription cost analysis (PCA) system and the General Practice Research Database (GPRD).

Results Between 1991 and 2003, 4.5 million doses of PPV were prescribed. The GP survey found that by 2003, 29% of those 65 years and over of age and 36% of those 80 years of age over had received PPV. Sixty-two per cent of general practices had implemented a risk-group-only policy, 14.4% had targeted all those 65 years of age over and 14.2% had targeted all those 75 years of age over. The GPRD study found that 38% of those 65 years over and 41% of those 80 years over fell into one or more high-risk groups. By 2003, 36.6% of the high-risk group and 30.2% of all those 65 years over had ever been vaccinated. Vaccine uptake increased with age, with 52.3% of the high-risk group and 37% of all those 80 years over having ever been vaccinated.

Conclusions A large proportion of those in risk groups remained unvaccinated with PPV in 2003. Formal evaluation of the impact and effectiveness of the universal elderly immunization programme will be required.

Keywords: coverage, elderly, pneumococcal polysaccharide vaccine.
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