Hepatitis C Performance Measure on Hepatitis A and B Vaccination: Missed Opportunities?
Hepatitis C Performance Measure on Hepatitis A and B Vaccination: Missed Opportunities?
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DOI：
10.1038/ajg.2009.252
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发表时间：
2009-08-01
影响因子：
9.8
通讯作者：
Cheung, Ramsey
中科院分区：
文献类型：
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作者：
Hernandez, Bridget;Hasson, Noelle K.;Cheung, Ramsey
目的：通过疫苗接种预防慢性丙型肝炎（CHC）患者的甲型肝炎病毒（HAV）和乙型肝炎病毒（HBV）感染已得到所有主要专业协会的认可。本研究的目的是确定最近采用的HAV和HBV疫苗接种医师绩效指标的依从性。方法：回顾性研究。分析了2000年至2007年间可检测到丙型肝炎病毒（HCV） RNA的CHC患者的甲型和乙型肝炎血清学数据和免疫记录。结果：共纳入2968例CHC患者。其中，2143名患者（72%）接受了甲肝易感性检测，其中53%具有免疫力。在未免疫的患者中，746人（74%）接种了疫苗，另外218人没有事先检测。对于HBV， 2303例（78%）患者接受了免疫检测，782例（34%）患者免疫。在易感患者中，1086例（71%）接种了疫苗，另外197例患者没有事先进行检测。总体疫苗接种绩效测量依从率为甲型肝炎71%，乙型肝炎70%，甲型肝炎和乙型肝炎均62%。对176张图表的随机审查发现，不遵守的主要原因是错失机会（41%），卫生保健系统的变化（31%），以及在我们的卫生保健系统之外记录的疫苗接种（22%）。结论：我们的研究发现患者对建议的依从性较高且有所改善，但错过机会仍然是不遵守建议的主要原因。本研究也支持在退伍军人人群中选择性接种疫苗的策略。
OBJECTIVES: Prevention of hepatitis A virus (HAV) and hepatitis B virus (HBV) infection in patients with chronic hepatitis C (CHC) through vaccination is endorsed by all major professional societies. This study was conducted to determine adherence to the recently adopted physician performance measure on HAV and HBV vaccination.METHODS: This was a retrospective study. Hepatitis A and B serology data and immunization records between 2000 and 2007 from CHC patients with detectable hepatitis C virus (HCV) RNA were analyzed.RESULTS: A total of 2,968 CHC patients were included in the study. Of these, 2,143 patients (72%) were tested for susceptibility to HAV, of which 53% had immunity. Of the non-immune patients, 746 (74%) were vaccinated as well as an additional 218 without prior testing. For HBV, 2,303 patients (78%) were tested for immunity and 782 (34%) were immune. Of the susceptible patients, 1,086 (71%) were vaccinated as well as an additional 197 patients without prior testing. The overall vaccination performance measure adherence rate was 71% for HAV, 70% for HBV, and 62% for both HAV and HBV. Random review of 176 charts found the major reasons for non-adherence were missed opportunity (41%), change of health care system (31%), and documented vaccination outside our health care system (22%).CONCLUSIONS: Our study found a high and improved adherence to the recommendations, but missed opportunity was still the main reason of non-adherence. This study also supported the strategy of selective vaccination in the veteran population.