Adolescent Tdap Vaccine Use Among Primary Care Physicians
Adolescent Tdap Vaccine Use Among Primary Care Physicians
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DOI：
10.1016/j.jadohealth.2008.08.019
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发表时间：
2009-04-01
影响因子：
7.6
通讯作者：
Clark, Sarah J.
中科院分区：
文献类型：
--
作者：
Dempsey, Amanda F.;Cowan, Anne E.;Clark, Sarah J.
目的：2006年，免疫实践咨询委员会(ACIP)建议用联合破伤风类毒素、减毒白喉类毒素和无细胞百日咳疫苗(TDAP)取代青少年破伤风和白喉类毒素(TD)增强剂。我们调查了儿科医生和家庭医生采纳这一建议的程度。方法：从2007年1月至3月，通过全国邮寄方式随机抽取725名儿科医生和725名家庭医生进行调查。结果：总体回复率为60%。大多数受访者表示，他们经常建议11-12岁的青少年接种Tdap(87%)，并在13-18岁的青少年中“追赶”接种(89%)。在双变量分析中，儿科医生专业、专科学会会员、在办公室储存TDAP以及先前诊断青少年百日咳的经验与定期向青少年推荐TDAP有关。在同时调整这些因素的多因素模型中，只有儿科医生的专业(OR=4.8，95%CI=2.5~9.3)和在办公室储存TDAP(OR=14.5，95%CI=7.5~28.5)仍然与常规推荐显著相关。儿科医生明显比家庭医生更愿意接受TD疫苗接种后较短的时间间隔来实施TDAP，并与MCV4共同实施TDAP。青少年探视不足是青少年TDAP管理最常见的主要障碍。结论：基于自我报告，我们的结果表明，大多数医生已经采纳了ACIP最近的建议来管理青少年TDAP。然而，基于专业的不同态度和做法仍然存在，这表明需要继续努力激励医生向青少年推荐这种疫苗，并澄清如何将TDAP与其他青少年疫苗相结合。(C)2009年青少年医学会。版权所有。
Purpose: In 2006 the Advisory Committee on Immunization Practices (ACIP) recommended replacement of the adolescent tetanus and diphtheria toxoids (Td) booster with combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap). We examined the degree to which pediatricians and family practitioners have adopted this recommendation.Methods: National mail-based survey of a random sample of 725 pediatricians and 725 family practitioners from January through March, 2007.Results: Overall response rate was 60%. The majority of respondents indicated they routinely recommended Tdap to adolescents at the preferred age for vaccination, 11-12 years old (87%), and also for "catch up" vaccination among adolescents 13-18 years old (89%). In bivariate analyses, pediatrician specialty, specialty society membership, stocking Tdap in the office, and prior experience diagnosing adolescent pertussis were associated with routinely recommending Tdap to adolescents. In multivariable models adjusting for these factors simultaneously, only pediatrician specialty (OR = 4.8, 95% Cl = 2.5-9.3) and stocking Tdap in the office (OR = 14.5,95% Cl = 7.5-28.5) remained significantly associated with routine recommendation. Pediatricians were significantly more likely than family practitioners to accept shorter time intervals for administering Tdap following Td vaccination, and to co-administer Tdap with MCV4. Lack of adolescent visits was the most commonly cited major barrier to adolescent Tdap administration.Conclusions: Based on self report, our results indicate the majority of physicians have adopted recent recommendations from the ACIP to administer Tdap to adolescents. However, specialty-based disparifies in attitudes and practices persist, suggesting that ongoing efforts are needed to motivate physicians to recommend this vaccine to adolescents and to clarify how to integrate Tdap with other adolescent vaccinations. (C) 2009 Society for Adolescent Medicine. All rights reserved.