Patterns of Primary Care Physician Visits for US Adolescents in 2014: Implications for Vaccination
Patterns of Primary Care Physician Visits for US Adolescents in 2014: Implications for Vaccination
复制标题
DOI：
10.1016/j.acap.2018.01.002
复制
发表时间：
2018-03-01
影响因子：
3.1
通讯作者：
Goldstein, Nicolas P. N.
中科院分区：
文献类型：
--
作者：
Rand, Cynthia M.;Goldstein, Nicolas P. N.
目的：由于大多数青少年疫苗接种是在初级保健中提供的，因此接种疫苗的机会取决于就诊的存在和就诊的类型。我们评估了：1）全美青少年的国家就诊模式（每年与医生进行预防性就诊，所见的提供者类型，就诊类型），以及2）该年龄组接种疫苗的医生就诊类型。方法：我们对2014年医疗支出面板调查进行了二级数据集分析。通过对美国非制度化人口的全国代表性样本的照顾者进行访谈收集数据。我们使用描述性分析，以检查使用的卫生保健，根据年龄和性别，并访问类型的疫苗，根据age.RESULTS：在12个月的时间内，几乎一半的参与者没有初级保健医生（PCP）的访问，和三分之一的预防性访问PCP。另有19%的人只接受过PCP的非预防性护理。没有保险的参与者没有护理的比例最高，预防性护理的比例最低。11至17岁青少年的预防保健就诊主要是儿科医生，18至21岁青少年的就诊主要是家庭医生/全科医生。总体而言，67%的非检查PCP就诊是为了急性护理，10%是为了随访，7%仅是为了免疫接种。在全国范围内，61%，26%和12%的疫苗在预防，仅免疫接种，和急性/随访visits.CONCLUSIONS：不到一半的青少年接受预防保健，许多没有PCP访问。这就更有必要向青少年提供外展服务，以提高预防性就诊率，并利用所有初级保健就诊进行接种。由于儿科医生和家庭医生/全科医生为大多数青少年接种疫苗，这些提供者应继续成为疫苗教育和质量改进活动的目标受众。
OBJECTIVE: Because most adolescent vaccinations are delivered in primary care, opportunities to vaccinate depend on the presence of visits and types of visits. We evaluated: 1) national visit patterns (having an annual preventive visit with a physician, provider type seen, visit types) for adolescents across the United States, and 2) the type of physician visits at which vaccines are administered for this age group.METHODS: We performed a secondary data set analysis of the 2014 Medical Expenditure Panel Survey. Data are collected through interviews of caregivers of a nationally representative sample of the noninstitutionalized US population. We used descriptive analyses to examine use of health care according to age and gender, and visit types at which vaccines were given according to age.RESULTS: During a 12-month period, almost half of participants had no primary care physician (PCP) visits, and one-third had a preventive visit to a PCP. An additional 19% had only nonpreventive care visits to a PCP. Uninsured participants had the highest rate of no care, and the lowest rate of preventive care. Most preventive care visits by adolescents 11 to 17 years of age were to pediatricians, and most visits among those 18 to 21 years of age were to family/general practitioners. Overall, 67% of non check-up PCP visits were for acute care, 10% were for follow-up, and 7% for immunization only. Nationally, 61%, 26%, and 12% of vaccines were given at preventive, immunization-only, and acute/follow-up visits, respectively.CONCLUSIONS: Fewer than half of adolescents receive preventive care, and many have no PCP visits. This reinforces the need to offer outreach to adolescents to improve rates of preventive visits, and to take advantage of all primary care visits for vaccinations. Because pediatricians and family practice/general practice physicians vaccinate most adolescents, these providers should remain the target audience for vaccine education and quality improvement activities.