Barriers to Pretransplant Immunization: A Qualitative Interview Study of Pediatric Solid Organ Transplant Stakeholders.
Barriers to Pretransplant Immunization: A Qualitative Interview Study of Pediatric Solid Organ Transplant Stakeholders.
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DOI：
10.1016/j.jpeds.2020.07.038
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Morris MA
中科院分区：
文献类型：
--
作者：
Feldman AG;Marsh R;Kempe A;Morris MA
描述儿科移植利益相关者关于导致移植前免疫率低的因素的经验和信念。在美国三个地理位置不同的大型儿科移植中心，对移植团队成员（肝病专家、心脏病专家、肾病专家、移植护士协调员和移植传染病医生）、初级保健医生和心脏、肝脏和肾脏移植受者的父母进行了半结构化访谈。访谈在2017年7月至2020年2月期间进行，直到每个利益相关者分组达到主题饱和。利用内容分析方法确定主题。利益相关者参加了30-60分钟的访谈（16名移植专科医生，3名移植传染病医生，11名移植护士协调员，12名初级保健医生和40名父母）。出现了五个中心主题：（1）对移植前免疫接种的时间和安全性的认识存在差距，（2）团队成员之间缺乏关于免疫接种的沟通、协调和跟进，（3）缺乏集中的免疫接种记录，（4）专科诊所作为移植候选人的医疗之家，但无法提供所有需要的免疫接种，以及（5）器官类型之间在优先级和完成预移植免疫有多种因素导致儿科移植候选人的免疫接种率低。需要新的工具来克服这些障碍，提高移植候选人的免疫接种率。
To describe the experiences and beliefs of pediatric transplant stakeholders regarding factors that contribute to low pre-transplant immunization rates. Semi-structured interviews were conducted with transplant team members (hepatologists, cardiologists, nephrologists, transplant nurse coordinators and transplant infectious diseases physicians), primary care physicians, and parents of heart, liver and kidney transplant recipients at three geographically diverse large pediatric transplant centers in the United States. Interviews were conducted between July 2017 and February 2020 until thematic saturation was reached within each stakeholder subgroup. Content analysis methodology was utilized to identify themes. Stakeholders participated in 30-60-minute interviews (16 transplant subspecialists, 3 transplant infectious diseases physicians, 11 transplant nurse coordinators, 12 primary care physicians, and 40 parents). Five central themes emerged: (1) gaps in knowledge about timing and safety of pre-transplant immunizations, (2) lack of communication, coordination and followup between team members regarding immunizations, (3) lack of centralized immunization records, (4) subspecialty clinic functioning as the medical home for transplant candidates but unable to provide all needed immunizations and (5) differences between organ type in prioritization and completion of pre-transplant immunization. There are multiple factors that contribute to low immunization rates amongst pediatric transplant candidates. New tools are needed to overcome these barriers and increase immunization rates in transplant candidates.
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