Szilagyi P G, Rodewald L E
University of Rochester School of Medicine and Dentistry, New York, USA.
J Public Health Manag Pract. 1996 Winter;2(1):18-25. doi: 10.1097/00124784-199600210-00005.
Employing a literature review approach, this article explores the evidence about missed opportunities for childhood immunizations, their impact on immunization rates, and potential solutions. It concludes that missed opportunities contribute significantly to the underimmunization of children. A concerted effort to reduce missed opportunities, particularly those that are relatively easy to eliminate, could yield measurable improvements in immunization levels of children. Missed opportunities for vaccinations have been found to occur in virtually all primary care settings, and their impact is greater for populations having low baseline immunization rates. Coverage levels could be improved by up to 30% in many settings by eliminating missed opportunities. Major reasons for missed opportunities include providers lacking knowledge about immunization status, provider or practice policies resulting in failure to vaccinate, and inappropriate contraindications. Solutions include promulgation and acceptance of useful guidelines for delivery of immunizations, provider and patient education, assessment and feedback about a practice's missed opportunities, and modification of routine practice styles within primary care and other health care settings.
本文采用文献综述的方法，探讨了儿童免疫接种错失机会的相关证据、其对免疫接种率的影响以及潜在的解决方案。研究得出结论，错失机会是导致儿童免疫接种不足的重要因素。齐心协力减少错失机会，尤其是那些相对容易消除的机会，能够显著提高儿童的免疫接种水平。几乎在所有初级保健机构中都发现了疫苗接种错失机会的情况，而且对于基线免疫接种率较低的人群，其影响更大。在许多情况下，通过消除错失机会，免疫接种覆盖率可提高多达30%。错失机会的主要原因包括医护人员缺乏免疫接种状态的相关知识、医护人员或医疗机构的政策导致未能接种疫苗以及不恰当的禁忌证。解决方案包括颁布并接受实用的免疫接种实施指南、对医护人员和患者进行教育、评估并反馈医疗机构的错失机会情况，以及改变初级保健和其他医疗保健机构的常规诊疗方式。
