Quality improvement – applications in General Practice, planning for end of pandemic

Summary: This blog presents a summary of Quality Improvement methodology and applies it to a question highly relevant to General Practice – how to move away from same day appointments as Covid-19 lockdown loosens, but without overwhelming services. It focuses in on mental health – with an example sequence of PDSA cycles solely for illustrative purposes. It shows how a series of patient encounters (in this case calls to reception to make GP appointments) represents an opportunity for rapid testing, developing an approach that meets the needs of patients and potentially taking pressure off GPs while also providing more patient centred care. The ideas are presented for discussion rather than as a fait accompli. In real life the process of scoping and running a QI project with a team throws up lots of surprises and shakes a lot of assumptions.

I wrote this blog while reflecting on recent discussions with colleagues in a number of settings. It is presented here as a “think piece”, and will hopefully generate discussion in the comments box below. What are your experiences of using QI methods in general practice and other clinical settings?

Dr Graham Mackenzie GP specialty trainee, year 3 of training

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Hashtags from all tweets in the extract (n=31,031 hashtags from 10,604 tweets)

World Immunization Week 24-30 April 2020: A rapid review of pro- and anti- vaccination activity at the peak of the COVID-19 pandemic

I wrote this piece at the start of May 2020. It wasn’t accepted by a peer reviewed journal at that time, so I am providing it here as a blog instead. You can read the accompanying Wakelet summary of tweets (pro-vaccination) here.


Public attitudes on vaccination are of interest during the COVID-19 pandemic. Social media activity provides a route to unprompted views on vaccination. This study captures global tweeting during the World Immunization Week 24-30 April 2020, with a particular focus on describing the antivaccination content but avoiding identifying the tweeters or the individual tweets to avoid disseminating their views further.

Tweets using the official campaign hashtag #VaccinesWork and related terms including plain English phrases (“World Immunization Week”) and hashtags (e.g. #WorldImmunizationWeek) were extracted using an online social media tool (TAGS). Tweets and retweets were then imported into the NodeXL Excel extension at the end of the week to obtain the most up to date data on number of retweets received, hashtags used and characteristics of tweeters and retweeters. The top 200 tweets based on retweets were identified and antivaccination posts (n=5) used to identify tweeters and retweeters, repeating this six times and performing a further search based on commonly used antivaccination hashtags.

In total there were 10,946 tweets by 6,264 tweeters, with 53,124 retweets by 32,445 retweeters. The great majority of the most popular tweets were pro-vaccination. However, after an analysis of the most popular antivaccination posts, the accounts retweeting these posts, and the specifically antivaccination hashtags used, 218 antivaccination tweets were identified, posted by 89 tweeters, with 724 retweets made by 518 retweeters. These tweets disseminated common antivaccination myths, including material that inverted comments by senior officials to dispute vaccine safety/ efficacy.

This rapid analysis captures and describes some of the most popular pro- and anti-vaccination tweets from the April 2020 World Immunization Week, helping understand public views on vaccination globally at the height of the COVID-19 pandemic.

The full analysis is provided below, including word clouds of hashtags used by the different communities. You can also download this as a PDF file.

Funding: No external funding

No conflict of interest

Dr Graham Mackenzie, MD FRCP(Edinburgh), @gmacscotland on Twitter (4 May 2020, updated 10 April 2021)

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