Reducing missed opportunities for immunizations - Easier said than done
Reducing missed opportunities for immunizations - Easier said than done
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DOI：
10.1001/archpedi.1996.02170360083014
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发表时间：
1996-11-01
影响因子：
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通讯作者：
Woodin, KA
中科院分区：
文献类型：
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作者：
Szilagyi, PG;Rodewald, LE;Woodin, KA
背景：错过免疫机会与学龄前儿童免疫不足有关。将免疫接种限制为定期预防性就诊的实践政策和要求法定监护人签署疫苗接种同意书的指南是导致错失机会的两个因素。然而，改变这些政策的方法尚未得到充分评估。目的：衡量以下措施的有效性：(1) 改变实践政策，纳入新的国家标准，在所有就诊时对符合条件的儿童进行筛查和疫苗接种，以及 (2) 消除法定监护人签名要求。设计：一项包含 2 项干预措施的随机对照试验：(1) 改变实践政策和常规，让办公室护士在所有就诊时筛查免疫状况，在符合条件的患者的病历上附上免疫提醒卡，并让提供者为符合条件的儿童接种疫苗（“不”）。错失机会”干预）和（2）改变实践指南，允许在没有法定监护人签名的情况下接种疫苗。第一次干预在两个地点进行；第二个仅在邻里健康中心 (NHC)。地点：教学医院的儿科连续性诊所（以下简称诊所）和 NHC。患者：参加试验的是 1005 名诊所患者和 983 名 NHC 患者，年龄为 0 至 2 岁。主要结果指标：错失机会率、免疫接种率和预防服务率。结果：消除了法定监护人的要求签名对任何结果衡量都没有影响。不错过机会的干预措施取得了部分效果。在每个研究中心，研究患者的错失机会均略少于对照患者：（诊所每位患者每年 0.60 次 vs 0.90 次，P=0.01；NHC 每位患者每年 1.1 次 vs 1.3 次，P=0.02）。对于研究组患者，只有三分之一的符合疫苗接种资格的就诊患者在病历上附有免疫提醒卡；附上后，提供者的疫苗接种量显着增加（与附有免疫提醒卡和未附有免疫提醒卡的访问相比，每次就诊时接种疫苗的优势比为 6.9）。然而，在研究结束时，每个地点的研究组和对照组的免疫率相似。诊所不错过机会研究组的疫苗接种不足天数略低于对照组（56 天 vs 77 天，P
Background: Missed opportunities for immunizations are associated with underimmunization of preschool-age children. Practice policies limiting immunizations to scheduled preventive visits and guidelines requiring legal guardians to sign consent forms for vaccinations are 2 factors contributing to missed opportunities. However, methods to change these policies have not been sufficiently evaluated.Objective: To measure the effectiveness of(1) changing practice policies to incorporate the new national standard to screen and vaccinate eligible children at all office visits and (2) eliminating legal guardian signature requirements.Design: A randomized controlled trial of 2 interventions: (1) changing practice policy and routine to have office nurses screen for immunization status at all visits, attach immunization reminder cards to medical charts for eligible patients, and have providers vaccinate eligible children (''no missed opportunities'' intervention) and (2) changing practice guidelines to allow vaccinations without a legal guardian's signature. The first intervention was performed at both sites; the second only at the neighborhood health center (NHC).Setting: A Pediatric Continuity Clinic in a teaching hospital (hereafter referred to as Clinic), and an NHC.Patients: Enrolled in the trial were 1005 Clinic patients and 983 NHC patients, 0 to 2 years of age.Main Outcome Measures: Missed opportunity rates, immunization rates, and rates of preventive services.Results: Eliminating the requirement for a legal guardian's signature had no effect on any of the outcome measures. The no missed opportunities intervention was partially effective. Study patients had slightly fewer missed opportunities than control patients at each site: (0.60 vs 0.90 per patient per year at the Clinic, P=.01; 1.1 vs 1.3 per patient per year at the NHC, P=.02). For study group patients, immunization reminder cards were attached to medical charts in only one third of vaccine-eligible visits; when attached, they markedly increased vaccination by providers (odds ratio for vaccinating at a visit was 6.9 comparing visits when immunization reminder cards were attached vs not attached). However, at the end of the study, immunization rates were similar for study and control groups at each site. The number of undervaccinated days was slightly lower for the no missed opportunities study group at the Clinic than for the control group (56 days vs 77 days, P