Missed opportunities for influenza vaccination in children with chronic medical conditions
Missed opportunities for influenza vaccination in children with chronic medical conditions
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DOI：
10.1001/archpedi.159.10.986
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发表时间：
2005-10-01
影响因子：
--
通讯作者：
Kempe, A
中科院分区：
文献类型：
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作者：
Daley, MF;Beaty, BL;Kempe, A
目的：在设计：前瞻性队列研究中评估患有慢性疾病的儿童和未免疫儿童错过流感免疫机会的频率和特征。数据来自账单和免疫组，以探讨家长报告的不给孩子接种疫苗的原因。登记数据库和对家长的电话访谈。地点：2002-2003 年流感季节期间，科罗拉多州丹佛市的四个儿科诊所。参与者：患有 1 种或多种慢性疾病的 6 至 72 个月的儿童。主要结果指标：错失流感免疫机会，定义为有过付费接种、有资格接种疫苗和未接受疫苗。将患有哮喘的受试者与患有其他疾病的受试者分开进行分析。结果：我们确定了 926 名患有慢性疾病的儿童：820 名（89%）仅患有哮喘，106 名（11%）患有其他疾病。在所有符合疫苗接种条件的哮喘儿童就诊中，有 78% 的人错过了机会，在患有其他疾病的儿童的所有就诊中，有 74% 的人错过了机会。对于患有哮喘的儿童，12 月和 1 月符合疫苗接种资格的就诊中有 92% 导致错失机会，而 10 月和 11 月这一比例为 69%；对于患有其他疾病的儿童，相应的频率分别为 86% 和 68%。对于患有哮喘的儿童，86% 的非健康儿童就诊导致错失机会，而健康儿童就诊的比例为 62%；在患有其他慢性病的儿童中也发现了类似的频率。未接种疫苗的儿童的家长报告说，缺乏医生建议和对流感的易感性较低是他们的孩子不接种疫苗的主要原因。结论：错过机会在很大程度上导致患有慢性疾病的儿童的流感免疫率较低。
Objectives: To assess the frequency and characteristics of missed opportunities for influenza immunization in children with chronic medical conditions and, among unimmunized children inDesign: Prospective cohort study. Data were obtained from billing and immuthat group, to explore parent-reported reasons for not vaccinating their child. nization registry databases and telephone interviews of parents.Setting: Four pediatric practices in metropolitan Denver, Colo, during the 2002-2003 influenza season.Participants: Children aged 6 to 72 months with 1 or more chronic medical conditions.Main Outcome Measure: A missed opportunity for influenza immunization, defined as having a billed encounter, being eligible for immunization, and not receiving vaccine. Subjects with asthma were analyzed separately from those with other conditions.Results: We identified 926 children with chronic conditions: 820 (89%) with asthma only and 106 (11%) with other conditions. Missed opportunities occurred at 78% of all vaccine-eligible visits for children with asthma and 74% of all visits for children with other conditions. For children with asthma, 92% of vaccine-eligible visits in December and january resulted in a missed opportunity vs 69% in October and November; for children with other conditions, corresponding frequencies were 86% vs 68%, respectively. For children with asthma, 86% of non-well-child visits resulted in a missed opportunity, compared with 62% of well-child visits; similar frequencies were seen among children with other chronic conditions. Parents of unimmunized children reported lack of a physician recommendation and low perceived susceptibility to influenza as the primary reasons for not immunizing their child.Conclusion: Missed opportunities contribute significantly to low influenza immunization rates among children with chronic medical conditions.