Use of Standing Orders for Vaccination Among Pediatricians.
Use of Standing Orders for Vaccination Among Pediatricians.
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DOI：
10.1542/peds.2019-1855
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发表时间：
2020-05
期刊：
影响因子：
8
通讯作者：
Kempe, Allison
中科院分区：
文献类型：
--
作者：
Cataldi, Jessica;O'Leary, Sean T.;Lindley, Megan C.;Allison, Mandy A.;Hurley, Laura P.;Crane, Lori A.;Brtnikova, Michaela;Beaty, Brenda;McBurney, Erin;Kempe, Allison
常备订单是提高疫苗接种率的有效方法，但人们对儿科医生如何使用这种策略进行儿童免疫接种知之甚少。我们评估了目前使用的，使用的障碍，并与儿科医生使用常备订单接种疫苗的相关因素。2017年6月至9月在全国代表性儿科医生样本中进行的互联网和邮件调查。障碍项目的主成分分析确定了两个因素：医生的责任和关注办公室流程。多变量分析，包括障碍尺度和医生/实践的特点，用于确定与使用常备订单的因素。有效率为79%（372/471）。59%的受访者表示使用常规订单。非使用者中最常见的障碍是担心患者可能错误地接种疫苗（68%），担心患者在接种疫苗之前更喜欢与医生谈论疫苗（62%），以及认为医生是向患者推荐疫苗的人（57%）。这三项也构成了医师责任障碍因素。具有较高医生责任分数的受访者不太可能使用长期订单（RR 0.59，95% CI：每增加一分0.53-0.66）。在双变量分析中，关于疫苗、郊区/农村位置的系统级决策以及对办公室流程评分的较低关注均与长期订单的使用相关，但与多变量分析无关。在儿科医生中，使用常规疫苗接种的情况远非普遍。干预措施，以增加使用常备订单应解决医生的态度障碍，以及组织因素。儿科医生确定了使用常规的几个障碍，包括对医生在疫苗接种的沟通和交付中的重要作用的担忧。
Standing orders are an effective way to increase vaccination rates, yet little is known about how pediatricians use this strategy for childhood immunizations. We assessed current use of, barriers to using, and factors associated with use of standing orders for vaccination among pediatricians. Internet and mail survey from June-September 2017 among a nationally representative sample of pediatricians. Principal component analysis of barrier items identified two factors: Physician Responsibility and Concerns about Office Processes. Multivariable analysis including barrier scales and physician/practice characteristics was used to identify factors associated with use of standing orders. Response rate was 79% (372/471). 59% of respondents reported using standing orders. Most commonly identified barriers among non-users were concern patients may mistakenly receive the wrong vaccine (68%), concern patients prefer to speak with the physician about a vaccine before receiving it (62%), and belief that it is important for the physician to be the person who recommends a vaccine to patients (57%). These three items also made up the Physician Responsibility barrier factor. Respondents with higher Physician Responsibility scores were less likely to use standing orders (RR 0.59, 95% CI: 0.53-0.66 per point increase). System level decision-making about vaccines, suburban/rural location, and lower Concerns about Office Processes score were each associated with use of standing orders in bivariate but not multivariable analysis. Among pediatricians, use of standing orders for vaccination is far from universal. Interventions to increase use of standing orders should address physicians’ attitudinal barriers as well as organizational factors. Pediatricians identify several barriers to using standing orders including concerns about the importance of the physician’s role in communication about and delivery of vaccinations.
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