Tackling disparities in influenza vaccination in primary care: it takes a team.
Tackling disparities in influenza vaccination in primary care: it takes a team.
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解决初级保健中流感疫苗接种的差异：需要一个团队。
DOI：
10.1007/s11606-014-2999-2
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发表时间：
2014
影响因子：
5.7
通讯作者：
Fiscella,Kevin
中科院分区：
文献类型：
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作者：
Fiscella,Kevin
不理想的流感疫苗接种率与不必要的心血管死亡有关。流感疫苗接种中持续存在的种族和民族差异可能导致非洲裔美国人心血管死亡率较高。1在本期JGIM中，Maurer等人评估了办公室流感疫苗接种实践中错过的机会对这些疫苗接种中种族和民族差异的影响。2作者得出结论，改进基于办公室的做法可以提高疫苗接种率并减少差异。他们说得对吗？作者研究了2010年进行的全国互联网调查的自我报告数据，以评估这个问题。他们发现，消除错过的机会将减少流感疫苗接种率的种族和民族差异。具体而言，如果提供者建议接种疫苗，对所有至少接受过一次医疗保健访问并表示愿意接种疫苗的患者进行接种，将使差距减少一半。经过几十年的温和进展，流感疫苗接种差异减少50%将对少数患者的流感并发症和死亡产生重大的全民影响。作者适当地承认了他们的发现应该伴随的警告。互联网调查忽略了那些上网率较低的人，包括那些受教育程度较低和卫生知识有限的人。被作者的调查方法遗漏的人是否会做出类似的反应尚不清楚。尽管如此，作者按种族和民族对疫苗接种的总体估计与同年非互联网国家调查的结果接近。另一个警告是，患者报告他们对假设场景的反应可能不一定反映他们的实际行为。最后，这项研究没有考虑到办公室访问的次数，只考虑了该人是否报告至少一次访问。然而，初级保健访问的数量对流感疫苗接种的差异影响不大。3.总之，作者
S uboptimal influenza vaccination rates are associated with needless cardiovascular deaths. Persistent racial and ethnic disparities in influenza vaccination likely contribute to higher cardiovascular mortality for African Americans. 1 In this issue of JGIM, Maurer et al. assess the impact of missed opportunities within office practices for influenza vaccination on racial and ethnic disparities in these vaccinations. 2 The authors conclude that improved office-based practices could improve vaccine uptake and reduce disparities. Are they right?The authors examine self-report data from a national Internet survey conducted in 2010 to assess this question. They find that eliminating missed opportunities would reduce racial and ethnic disparities in influenza vaccination rates. Specifically, vaccination of all patients who have had at least one health care visit and who express a willingness to be vaccinated, if the provider has recommended it, would reduce disparities by half. After decades of modest progress, a 50% reduction in disparities in influenza vaccination would have a significant population-wide impact on influenza complications and deaths for minority patients. The authors appropriately acknowledge caveats that should accompany their findings. Internet surveys omit those with lower web access, including those with lower education and limited health literacy. Whether persons missed by the authors’ survey method would respond similarly is not clear. Nonetheless, the authors’ overall estimates of vaccination by race and ethnicity approximate those from non-Internet national surveys from the same years. Another caveat is that patient reports of how they would respond to a hypothetical scenario may not necessarily reflect how they actually behave. Finally, the study did not account for the number of office visits, only whether the person reported at least one visit. However, the number of primary care visits has only modest effects on disparities in influenza vaccinations. 3 In short, the authors’