[Gnumed-devel] Re: Vaccination Maintenance Module Progress

[Ian Haywood]

Karsten Hilbert wrote:

> Ian, could you help with this, too ?
My vaccination practice is (well, was, I'm working in psychiatry now)
quite different to most GPs in that I was generally vaccinating older children 
and
adults as catch-up.
In other words, I didn't follow the official schedule, I would do the 
appropriate
serologies, then vaccinate what was missing. (probably 30% of my patients have 
hepB antibody,
for example, either because they had chronic hep B, or had had it and cleared 
it, presumably as infants)

As have said, what I want is a widget which auto-computes the vaccines 
indicated today,
based on previous vaccines and age. So min_age represents the official 
schedule, the age at which
vaccines "appear" on the list, I need max_age too, for both clinical (adults 
don't get whooping cough)
and bureaucratic (chickenpox will only be subsidised between 18 months and 2 
years of age)

Ideally it would look at my serology results too, but this is not possible as 
serology (like all path) comes as
unparseable free text. Instead the user would manually dismiss a vaccine (and 
the rest of its sequence)
from the widget.


>>Maybe different, but one conceptual thing I've not come to terms with is when 
>>one sometimes has to give a booster say for rubella, but has to use an MMR 
>>vaccine (bad example), but you get the gist.
> 
> Yes, that's exactly part of the problem. The only clean
> solution is to link data at the database level at the
> single-indication level and then aggregate that into
> schedules vs. multi-epitope vaccines in higher levels -
> which is perfectly fine with me.
In Australia the Government generally subsidises one vaccine only for a 
specific position in the schedule,
the higher valencies often just aren't available.
(I'm thinking, for example, of the six-valent "Infanrix Hexa" which is 
MMR-diptheria-tetanus-pertussis, IIRC.)
Maybe in some rich area there are sensitive housewives who will pay ~$50 to 
save their little darling one more
needle, I don't see such individuals where I work ;-)

The point is, Australian schedules are printed with the vaccines by brand: "at 
six months, give Priorix(TM)"
This fits in with the wider medical culture which is largely brand-based. Horst 
is the only other
generic prescriber I know.
Richard is also dealing with a brand-based drug database, the database doesn't 
indicate what epitopes
a vaccine has. This is why (I think) he wants to tie specific vaccines to 
specific points on the schedule.

As is generally the case, Karsten has adopted a more conceptually pure 
solution, but this means more work for
use (we have to translate our schedule into a generic epitope-based one, then 
manually link vaccines
to epitopes, so the official schedule can be "re-constructed" by a join between 
these tables)
You can see for someone like Richard (whose mostly vaccinating off the 
schedule), it's extra work for no real gain.

I would vote for Karsten's, because it is more suited to my work (vaccinating 
by indication, not schedule)

I would add somewhere under sql/country-specific/au

ALTER TABLE vaccine ADD COLUMN au_subsidised boolean;

to mark which vaccines are paid-for.

Ian