Vaccine Delays, Refusals, and Patient Dismissals: A Survey of Pediatricians
Vaccine Delays, Refusals, and Patient Dismissals: A Survey of Pediatricians
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DOI：
10.1542/peds.2016-2127
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发表时间：
2016-09-01
期刊：
影响因子：
8
通讯作者：
O'Connor, Karen G.
中科院分区：
文献类型：
--
作者：
Hough-Telford, Catherine;Kimberlin, David W.;O'Connor, Karen G.
背景技术背景：父母不遵守美国儿科学会和疾病控制和预防中心的免疫接种计划是一个日益严重的公共卫生问题。我们研究了疫苗延迟和拒绝的请求的频率以及对美国儿科医生行为的影响。方法：使用2006年和2013年的美国儿科学会定期调查，我们描述了儿科医生对（1）疫苗拒绝和延迟，（2）父母拒绝和/或延迟的原因，以及（3）医生解雇的患病率的看法。有关疫苗延迟的问题仅在2013年提出。我们使用双变量和多变量分析来检查疫苗拒绝和延迟的频率、原因和管理，这些分析控制了实践特征、人口统计学和调查year.RESULTS：报告父母疫苗拒绝的儿科医生比例从2006年的74.5%增加到2013年的87.0%（P < .001）。儿科医生认为，越来越多的父母拒绝接种疫苗，因为父母认为疫苗是不必要的（2006年为63.4%，2013年为73.1%; P = 0.002）。共有75.0%的儿科医生报告父母因担心不适而推迟接种疫苗，72.5%的儿科医生表示因担心免疫系统负担而推迟接种。在2006年，6.1%的儿科医生报告说，“总是”解雇持续拒绝接种疫苗的患者，到2013年，这一比例增加到11.7%（P = .004）。他们认为，拒绝接种疫苗的父母越来越认为接种疫苗是不必要的。儿科医生继续提供疫苗教育，但也以更高的速度解雇病人。
BACKGROUND: Parental noncompliance with the American Academy of Pediatrics and Centers for Disease Control and Prevention immunization schedule is an increasing public health concern. We examined the frequency of requests for vaccine delays and refusals and the impact on US pediatricians' behavior.METHODS: Using national American Academy of Pediatrics Periodic Surveys from 2006 and 2013, we describe pediatrician perceptions of prevalence of (1) vaccine refusals and delays, (2) parental reasons for refusals and/or delays, and (3) physician dismissals. Questions about vaccine delays were asked only in 2013. We examined the frequency, reasons for, and management of both vaccine refusals and delays by using bivariate and multivariable analyses, which were controlled for practice characteristics, demographics, and survey year.RESULTS: The proportion of pediatricians reporting parental vaccine refusals increased from 74.5% in 2006 to 87.0% in 2013 (P < .001). Pediatricians perceive that parents are increasingly refusing vaccinations because parents believe they are unnecessary (63.4% in 2006 vs 73.1% in 2013; P = .002). A total of 75.0% of pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of pediatricians reported "always" dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% (P = .004).CONCLUSIONS: Pediatricians reported increased vaccine refusal between 2006 and 2013. They perceive that vaccine-refusing parents increasingly believe that immunizations are unnecessary. Pediatricians continue to provide vaccine education but are also dismissing patients at higher rates.