Ambulatory quality indicators to prevent infection in sickle cell disease
Ambulatory quality indicators to prevent infection in sickle cell disease
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DOI：
10.1002/ajh.23627
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发表时间：
2014-03-01
影响因子：
12.8
通讯作者：
Panepinto, Julie A.
中科院分区：
文献类型：
--
作者：
Beverung, Lauren M.;Brousseau, David;Panepinto, Julie A.
本研究的目的是确定Wang等人（Pediatrics 2011;128：484-493）指出的三个门诊质量指标的依从率：（1）流感疫苗，（2）肺炎球菌免疫接种，（3）医疗补助样本中镰状细胞病（SCD）患者的青霉素预防。这些变量的选择是基于Wang及其同事的建议，即这些变量对于评估SCD儿童的护理质量很重要。我们假设，总体依从性较差，成人的依从性比儿童差。我们使用威斯康星州的医疗补助数据库进行了一项为期5年的回顾性队列研究，以评估SCD患者的预防性药物依从性。本研究中的替代药物变量包括流感疫苗接种、肺炎球菌免疫接种（PCV 7、PPV 23）和青霉素预防。正如预测的那样，2003-2007年威斯康星州国家医疗补助数据库显示，SCD患者在推荐的流感疫苗接种（21.58%）、PPV 23肺炎球菌免疫接种（43.47%）和青霉素预防（18.18%）方面的依从性较低。PCV 7的肺炎球菌免疫接种率高于预期（77.27%粘附）。虽然儿童倾向于坚持推荐的预防性药物比成人多，总体依从性低。虽然我们无法解释为什么依从性低，但这可能是由于患者和提供者层面的多种因素。我们鼓励患者和提供者建立合作伙伴关系，以满足依从性建议，我们描述了我们的策略，以提高依从性。Am.血液学杂志89：256-260，2014. (c)2013 Wiley Periodicals，Inc.
The purpose of this study was to identify rates of adherence for three outpatient quality indicators noted by Wang et al. (Pediatrics 2011;128:484-493): (1) influenza vaccine, (2) pneumococcal immunizations, and (3) penicillin prophylaxis in patients with sickle cell disease (SCD) in a Medicaid sample. These variables were chosen based on Wang and colleagues' suggestion that these variables are important for the assessment of the quality of care of children with SCD. We hypothesized that the overall rate of adherence would be poor with adults having worse rates of adherence than children. We conducted a retrospective cohort study using the Wisconsin State Medicaid database over a 5-year period to assess the preventative medication adherence of individuals with SCD. Preventative medication variables in this study included influenza vaccination, pneumococcal immunizations (PCV7, PPV23), and penicillin prophylaxis. As predicted, the 2003-2007 Wisconsin State Medicaid database showed patients with SCD had low adherence in terms of recommended influenza vaccinations (21.58% adherent), PPV23 pneumococcal immunizations (43.47% adherent), and penicillin prophylaxis (18.18% adherent). Pneumococcal immunizations for PCV7 were higher than expected (77.27% adherent). Although children tended to adhere to recommended preventative medications more than adults, overall adherence was low. Although we cannot explain why adherence is low, it is likely due to multiple factors at the patient- and provider-level. We encourage patients and providers to create a partnership to meet adherence recommendations, and we describe our strategies for increasing adherence. Am. J. Hematol. 89:256-260, 2014. (c) 2013 Wiley Periodicals, Inc.