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Wang Q, Dai P, Jia M, Jiang M, Li J, Yang W, Feng L. Construction of an indicator framework for vaccine inclusion in public health programs: A Delphi-entropy method study. Hum Vaccin Immunother 2023; 19:2272539. [PMID: 37905961 PMCID: PMC10760382 DOI: 10.1080/21645515.2023.2272539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Governments must decide which vaccine priority to include in their public health programs. Using the modified Delphi and entropy method, we developed an indicator framework for vaccine inclusion at the national, provincial, municipal, and district/county levels, each containing three dimensions. In total, 4 primary indicators, 17 secondary indicators, and 45 tertiary indicators were selected, covering vaccine-preventable diseases, candidate vaccines, and social drivers of the supply and demand sides. From a subjective perspective, there was no significant weighting difference in the primary and secondary indicators at all administrative levels. "Vaccine-preventable diseases" as a primary indicator had the greatest weight in the peer group, of which "Health burden" had the highest weight among the secondary indicators. From the objective perspective, the social drivers on the supply and demand sides of the primary indicators accounted for 65% and higher. Among the secondary indicators, "the characteristics of the candidate vaccine" and "vaccine-related policies on the supply side" held 8% of weights or more at both national and provincial levels. "Demographic characteristics" held the highest weight at the municipal (13.50) and district/county (15.45) level. This study indicates that China needs different considerations when using WHO-recommended vaccines at the national, provincial, municipal, and district/county levels. In addition, this study highlights that behavioral and social drivers are important indicators that need to be considered for decision-making. This framework provides a tool for policymakers to determine the inclusion priority of candidate vaccines.
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Affiliation(s)
- Qing Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peixi Dai
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mengmeng Jia
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingyue Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Li
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing, China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Chew CC, Lim XJ, Letchumanan P, Narayanan MS, Rajan P, Chong CP. Development and validation of a pharmacist-led education model in allergic rhinitis management: a multi-phase study. J Pharm Policy Pract 2023; 16:116. [PMID: 37794504 PMCID: PMC10548631 DOI: 10.1186/s40545-023-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Patient education is identified as one of the core and fundamental management strategies in the management of allergic rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed guidance for the management of allergic respiratory disease, and the guidelines are applicable to the international context. The ARIA guidelines for the pharmacy have specifically encouraged the creation of local pharmacist-led intervention in allergic rhinitis management. This study aims to develop a pharmacist-led educational model using a multi-phase study approach. METHOD In phase one, we conducted a literature review using four databases to extract relevant articles and clinical practice guidelines published between 2017 and 2022. The information was structured into a questionnaire consisting of patient education material (10 domains with 130 items) and pharmacist counseling scopes (15 domains with 43 items), with each item having a rating scale ranging from 1 (lowest) to 9 (highest) level of agreement. Fifty-two panellists, including otorhinolaryngologists and pharmacists, were invited to complete the questionnaire. A consensus agreement was considered when at least 70% of panellists scored 7 to 9 (critically important). A two-round survey was conducted, and descriptive analysis, inter-rater reliability (≥ 0.5-1 indicate moderate to excellent reliability), variation in the relative interquartile (VRIR < 0.3 indicate good stability), and variation in the coefficient of variation (VCV < 40% considered consensus achieved) were performed. In phase two, patient education material was developed into audio-visual format, and in phase three, patients rated its understandability and actionability using a validated Patient Education Materials Assessment Tool. RESULTS In the round one Delphi survey, 43 panellists responded, with 171 out of 173 items achieving "consensus agreement" (75.4-100%). In the second survey, 32 out of 43 panellists responded, with most items (171 out of 173 items) stable across rounds and all items had acceptable internal consistency (VCV: - 12.21-15.81). Two items did not achieve "consensus agreement" (64%) but improved in round two (92.9%), however, instability was observed (VRIR: 0.36). These two items were retained in the model due to achieving the minimum level of agreement and internal consistency (VCV = 15.81). Inter-rater reliability was 0.608 and 0.970 in the respective rounds. Patients rated the educational material as understandable (81.8-100%) and actionable (100%). CONCLUSION The validated pharmacist-led education model, with its educational materials tested on end-users, provides structured patient education and pharmaceutical care in assisting patients with allergic rhinitis. The educational material allows the delivery of standardized information by the healthcare providers to the patients. Further research on the effectiveness of this model in improving patients' symptom control and quality of life is warranted.
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Affiliation(s)
- Chii-Chii Chew
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.
| | - Pathma Letchumanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Maithrea Suresh Narayanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Chee Ping Chong
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
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Ma C, Li J, Wang N, Wang Y, Song Y, Zeng X, Zheng C, An Z, Rodewald L, Yin Z. Prioritization of Vaccines for Inclusion into China’s Expanded Program on Immunization: Evidence from Experts’ Knowledge and Opinions. Vaccines (Basel) 2022; 10:vaccines10071010. [PMID: 35891174 PMCID: PMC9318118 DOI: 10.3390/vaccines10071010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023] Open
Abstract
Background: Vaccine developers in China have made an increasing number of infectious diseases preventable through vaccination. An appropriate decision-making procedure is necessary for making wise decisions on whether to introduce new vaccines into the Expanded Program on Immunization (EPI). When there are several vaccines that could potentially be considered, a scientifically justifiable mechanism is needed for prioritizing and sequencing vaccines for consideration. Methods: We used a modified Delphi technique (MDT) to develop and refine an indicator system to prioritize vaccines and make policy recommendations concerning their introduction into China’s EPI system. From January through May 2021, thirty-nine experts were recruited and participated in a two-round Delphi survey that was based on a set of candidate indicators obtained through a literature review and reference to the WHO vaccine introduction recommendations. Using the resulting indicator system, we conducted a third consultation with a multi-disciplinary group of experts who scored five program-eligible candidate vaccines to determine prioritization and sequencing for consideration of inclusion into the EPI. Results: Response rates of the thirty-nine experts were 100% and 97.4% across the two rounds. Authority coefficients from rounds one to three were over 0.70, reflecting the high accuracy and reliability of the consultation. Coordination coefficients of importance scores for primary, secondary, and tertiary indicators were 0.486, 0.356, 0.275 in round one, and 0.405, 0.340, and 0.236 in round two. According to the scores from 30 experts using our indicator system, the sequence and scores (1–10 scale, 10 highest) of 5 candidate vaccines were varicella (6.91), meningococcal conjugate AC (6.83), Hib (6.74), influenza (6.56), and EV71 (6.17) vaccines. Conclusions: A modified Delphi technique effectively built a scientific, rational, comprehensive, and systematic indicator system for prioritizing vaccine candidates for consideration of inclusion into the EPI. The rank order will be used by the technical working groups of China’s National Immunization Advisory Committee to sequentially develop and present Evidence-to-Recommendation tables for making policy recommendations.
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Affiliation(s)
- Chao Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Junhong Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Nan Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 201204, China;
| | - Yamin Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Yudan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Xiang Zeng
- Zhuhai Center for Disease Control and Prevention, Zhuhai 519000, China;
- Chinese Field Epidemiology Training Program (CFETP), Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Canjun Zheng
- Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 100050, China;
| | - Zhijie An
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Lance Rodewald
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
- Correspondence:
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Rosas-Flota X, Castillo-Martínez L, Reyes-Ramírez AL, Martínez-Soto Holguín MC, Serralde-Zúñiga AE. Adaptation of the medical-nutrition therapy for patients with intestinal failure in a developing country: A modified Delphi survey. Clin Nutr ESPEN 2020; 40:187-192. [PMID: 33183535 DOI: 10.1016/j.clnesp.2020.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Intestinal Failure (IF) is a complex disease with huge impacts on our society due to complications. Therefore, in a developing country like Mexico without specialized IF clinics, health care professionals must provide evidence-based interventions for the IF patient. This study aims to achieve consensus on how to adapt the existing guidelines for IF to the local practices considering the available resources and local practices. METHODS A three-round modified Delphi process was used to build consensus on the most important interventions for our IF patients. For each round, data was collected and consensus was defined as ≥80% of agreement for each item. Descriptive statistics were used to determine whether a consensus was achieved. RESULTS Ten content experts completed the three-round modified Delphi survey. Consensus was achieved for 98% of the items related to the hospitalized patient, ambulatory care management, and drug therapy. Some of these items are not included in the ESPEN guidelines for IF, but we considered that they are relevant in our clinical practice, like the calculation of fluids for patients with very low body weight, screening for refeeding syndrome and the use of some conventional drugs to promote intestinal rehabilitation. CONCLUSIONS Using a three-round modified Delphi process, consensus was achieved for nearly all items. This represents a starting point for the improvement of our local practices towards this complex disease, leading to better outcomes and the implementation of evidence-based protocolized interventions which can have an important impact due to the lack of access to some of the most novel pharmacological therapies like the glucagon-like-peptide (GLP-2) analog.
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Affiliation(s)
- Ximena Rosas-Flota
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Universidad Nacional Autónoma de México, Facultad de Medicina, Div. Estudios de Posgrado, Mexico.
| | - Lilia Castillo-Martínez
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Ana L Reyes-Ramírez
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Aurora E Serralde-Zúñiga
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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