The relation of parent and provider characteristics to vaccination status of children in private practices and managed care organizations in Maryland
The relation of parent and provider characteristics to vaccination status of children in private practices and managed care organizations in Maryland
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DOI：
10.1097/00005650-199901000-00008
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发表时间：
1999-01-01
期刊：
影响因子：
3
通讯作者：
Ross, A
中科院分区：
文献类型：
--
作者：
Hughart, N;Strobino, D;Ross, A
目标.本研究旨在确定提供者的做法和政策，在私人儿科设置，涉及疫苗接种状态，控制儿童的特点。疫苗接种数据来自马里兰州18个私人诊所和管理式护理组织的709名随机选择的2岁儿童的医疗记录，家庭数据来自466次与儿童父母的电话访谈，提供者特征来自18个现场问卷和42个个体医生和护士从业者问卷。Logistic回归和广义估计方程被用来估计供应商的特性与疫苗接种状态的关系。三个年龄适当的（AA）和两个最新的（UTD）疫苗接种状态变量的特征成功接种。约70%的研究儿童在2岁时接受了完整的疫苗接种系列，不包括B型肝炎疫苗。家庭人口学特征与疫苗接种不足的相关性最强，父母的免疫知识和态度以及儿童的保险覆盖率与疫苗接种状况无统计学相关性。现场提醒或后续系统和供应商的看法预约时间表和从卫生部门收到疫苗接种信息呈正相关。对责任的关注与年龄适当和最新疫苗接种的可能性降低有关。家庭人口统计学与疫苗接种状况密切相关;然而，它们通常不可修改，本研究的发现鼓励提供者操作跟踪系统，保持最新的免疫建议，使用所有临床接触来筛选和接种儿童，并确保疫苗接种服务的可用性和便利性。
OBJECTIVES. This study sought to identify provider practices and policies in private pediatric settings that relate to vaccination status, controlling for the characteristics of the children served.METHODS. Vaccination data came from the medical records of 709 randomly selected 2-year-old children at 18 private practices and managed care organizations in Maryland, family data from 466 telephone interviews with the children's parents, and provider characteristics from 18 site questionnaires and 42 individual physician and nurse practitioner questionnaires. Logistic regression and generalized estimating equations were used to estimate the relation of provider characteristics to vaccination status. Three age-appropriate (AA) and two up-to-date (UTD) vaccination status variables characterized successful vaccination.RESULTS. Approximately 70% of the study children were up-to-date by age 2 years for the full vaccination series, excluding hepatitis B vaccine. Family demographic characteristics were the strongest correlates of undervaccination, Neither parents' knowledge and attitudes about immunization nor the children's insurance coverage was statistically related to vaccination status. Site reminder or follow-up systems and provider perceptions about appointment scheduling and receipt of vaccine information from health departments were positively related to vaccination. Concern for liability was associated with a reduced odds of age-appropriate and up-to-date vaccination.CONCLUSIONS. Family demographics strongly correlate with vaccination status; however, they are generally not modifiable, This study's findings encourage providers to operate a tracking system, to remain current on immunization recommendations, to use all clinical encounters to screen and vaccinate children, and to ensure the availability and convenience of vaccination services.