Immunization practices of pediatricians and family physicians in the United States.
Immunization practices of pediatricians and family physicians in the United States.
复制标题
美国儿科医生和家庭医生的免疫实践。
作者：
P. Szilagyi;L. Rodewald;S. Humiston;J. Hager;K. Roghmann;C. Doane;L. Cove;G. V. Fleming;C. Hall
客观化
评估目前全美儿科医生和家庭医生对免疫接种的做法和态度。
设计
对儿科医生和家庭医生进行随机抽样的调查。
科目
美国儿科学会院士(N=746)和美国家庭医学学会院士(N=429)。调查主题：一般免疫实践(例如，提供疫苗接种的访问类型，识别接种不足儿童的机制)；以及对免疫接种障碍的看法，对替代免疫接种地点的接受，以及对医疗补助和妇女、婴儿和儿童特别补充食品计划(WIC)可能的免疫要求的意见。
结果
儿科医生和家庭医生(合计)报告如下：在急病就诊(28%)、随访(90%)和慢性病就诊(77%)期间为儿童接种疫苗；使用计算机或提醒文件识别接种不足的儿童(13%)；同时为符合条件的18个月大的儿童接种四种疫苗(白喉-破伤风-百日咳、口服脊髓灰质炎疫苗、麻疹、腮腺炎、风疹和b型流感嗜血杆菌)(66%)。医生认为以下是疫苗接种的障碍：错过预防性就诊(40%)、疫苗费用(24%)、缺乏保险覆盖(24%)、无法跟踪未接种疫苗的患者(22%)、免疫记录不完整(12%)、错过疫苗接种机会(12%)。医生同意在住院(51%)或急诊科就诊(30%)期间提供疫苗接种，并同意继续有资格获得医疗补助(66%)或WIC(%)的免疫接种要求。儿科医生更有可能在慢性病期间和后续访问期间接种疫苗，并且更有可能使用系统来跟踪接种不足的儿童(P<；.05)；然而，儿科医生和家庭医生的大多数免疫做法和态度是相似的。最近从医学院毕业的医生和那些在城市从事高风险工作的医生更有可能在急诊期间接种疫苗，同时提供疫苗接种，并倾向于在医院环境中接种疫苗。
结论
疫苗接种率可以通过在所有接触期间和同时接种疫苗时更密切地遵守关于接种疫苗的现行免疫指南、通过开发识别接种不足儿童的系统以及通过降低患者接种疫苗的费用来提高。目前的免疫做法不符合免疫指南；将要求改变个人做法的风格，以符合这些标准。
OBJECTIVE
To assess current practices and attitudes among pediatricians and family physicians across the United States regarding immunizations.
DESIGN
Survey of a random sample of pediatricians and family physicians.
SUBJECTS
Fellows of the American Academy of Pediatrics (N = 746) and American Academy of Family Medicine (N = 429). SURVEY TOPICS: General immunization practices (eg, types of visits during which vaccinations are provided, mechanisms to identify undervaccinated children); and opinions about perceived barriers to immunizations, acceptance of alternative sites for immunizations, and possible immunization requirements for Medicaid and The Special Supplemental Food Program for Women, Infants, and Children (WIC).
RESULTS
Pediatricians and family physicians (combined) reported the following: immunizing children during acute illness visits (28%), follow-up visits (90%), and chronic illness visits (77%); using computer or reminder files to identify undervaccinated children (13%); and simultaneously administering four vaccines (diphtheria-tetanus-pertussis, oral poliovaccine, measles, mumps, and rubella and Haemophilus influenzae type b) to an eligible 18-month-old child (66%). Physicians perceived the following as barriers to immunizations: missed preventive visits (40%), vaccine costs (24%), lack of insurance coverage (24%), inability to track undervaccinated patients (22%), incomplete immunization records (12%), and missed vaccination opportunities (12%). Physicians agreed with offering vaccinations during hospitalizations (51%) or emergency department visits (30%), and with immunization requirements for continued eligibility for Medicaid (66%) or WIC (64%). Pediatricians were more likely to vaccinate during chronic illness and follow-up visits, and were more likely to use systems to track undervaccinated children (P < .05); however, most immunization practices and attitudes of pediatricians and family physicians were similar. Physicians who graduated from medical school more recently and those in high-risk urban practices were more likely to vaccinate during acute illness visits, provide simultaneous vaccinations, and favor vaccinations in hospital settings.
CONCLUSIONS
Vaccination rates might be improved by closer adherence to current immunization guidelines regarding vaccinations during all encounters and simultaneous vaccinations, by developing systems to identify undervaccinated children, and by reducing patient costs for vaccinations. Current immunization practices fall short of the immunization guidelines; changes in individual practice styles will be required to conform with these standards.