Li, Jun; (1993) The use of child health computing systems in primary preventive care: An evaluation. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This study was undertaken in 10 districts, 5 in North East and 5 in North West Thames. The study subjects comprised a three month birth cohort (n=7841) born between January and March 1990 followed to age 19 to 21 months, and health visitors (n=340), child health managers (n=10) and computing system operating staff (n=68). The study 1) examined the quality of data available in the computing systems, 2) assessed the attitudes of health professionals to the computing systems and relevant aspects of child health services, and 3) evaluated the performance of pre-school immunisation and health surveillance programmes, using computing system data. In general, data in the computing system were considered accurate, up-to-date and (in terms of what was collected) complete. Certain problems were identified, especially regarding mobile children and families, where information was likely to be missing. As well as limitations in data transfer between localities/systems when children moved, poor standardisation of recording information was identified as a major shortcoming. Child health managers and system operating staff were satisfied with their presently used computing system in terms of facilitating the organisation of child health activities. However, most health visitors were more or less unsatisfied with the efficiency of the present system. Less than optimal communication between health professionals/localities, poor training of staff and incompatibilities between different computing systems were thought to be the most important factors affecting the performance of the child health systems. The results showed that running more health clinic sessions did not necessarily increase uptake of child health services. Uptake of immunisations had not met the 90% target in general for this three month birth cohort by the age of 19 to 21 months. Wide variation in uptake was found between groups of children, and cover rates were unacceptably low in certain sections of the child population. By and large, five risk factors were identified for low uptake of immunisations: living in a high deprived inner city district, being "allocated" to an immunisation location other than a general practitioner surgery, moving between districts, living with one parent and living in a larger family. Similar factors influenced surveillance uptake except that children registered to attend general practice were less likely to complete the programme. Variations were found across the study districts in terms of content of health checks at the two target surveillance ages, and the productivity of hearing assessments at six weeks and eight months was low. Child health computing systems are an important data source; although basically introduced for service, management and financial purposes they provide new epidemiological and research possibilities. Compared with those from "one-off' ad hoc epidemiological surveys, data stored in the systems are routinely collected, and therefore are available at no extra cost. The systems provide ongoing data allowing cross-sectional and longitudinal analyses and, particularly, if standardised and complete data variables can be collected routinely, provide opportunities for ongoing assessments of factors influencing uptake of services. Rapid feed back about the performance of preventive child health activities so allowing for rapid action can then be undertaken to improve uptake of child health services, so completing the research-audit-service loop.

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