Zimmerman R K, Mieczkowski T A, Raymund M
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, PA 15261, USA. zimmer+@pitt.edu
Am J Manag Care. 1999 May;5(5):574-82.
To quantify the national use and determinants of proactive immunization practices by examining the relationship to the primary practice payer.
A standardized survey was conducted in 1995 by trained personnel using computer-assisted telephone interviewing.
A stratified random sample of family physicians, pediatricians, and general practitioners across the United States was selected from the American Medical Association master file of physicians list, which included nonmembers. The main outcome measures were use of reminder systems and assessment of immunization rates.
Of the 1769 physicians who were contacted, 1236 participated. Use of reminder systems varied by the practice's primary payer: 31% of health maintenance organization (HMO), 41% of Medicaid, 27% of fee-for-service (FFS), and 28% of no predominant payment source physicians reported using a reminder system (P < 0.01). Use of computerized reminders also varied according to practice primary payer (HMO, 68%; Medicaid, 34%; FFS, 51%; and no predominant payment source, 42%; P < 0.01) as did assessment of immunization rates in the practice (HMO, 57%; Medicaid, 40%; FFS, 28%; and no predominant payment source, 30%; P < 0.01). A majority of Medicaid physicians (84%) required a physical examination before immunization, compared to 49% of HMO, 56% of FFS, and 63% of no predominant source physicians (P < 0.01).
The primary payment source of a practice appears to influence use of proactive immunization practices.
通过研究与主要执业支付方的关系，量化全国主动免疫实践的使用情况及决定因素。
1995年由经过培训的人员使用计算机辅助电话访谈进行了一项标准化调查。
从美国医学协会医生名单主文件中选取了美国各地的家庭医生、儿科医生和全科医生的分层随机样本，其中包括非会员。主要结局指标为提醒系统的使用情况和免疫接种率评估。
在联系的1769名医生中，1236名参与了调查。提醒系统的使用因执业的主要支付方而异：健康维护组织（HMO）的医生中有31%、医疗补助计划（Medicaid）的医生中有41%、按服务收费（FFS）的医生中有27%以及没有主要支付来源的医生中有28%报告使用了提醒系统（P<0.01）。计算机化提醒的使用也因执业主要支付方而异（HMO为68%；Medicaid为34%；FFS为51%；没有主要支付来源的为42%；P<0.01），执业中的免疫接种率评估情况也是如此（HMO为57%；Medicaid为40%；FFS为28%；没有主要支付来源的为30%；P<0.01）。大多数医疗补助计划的医生（84%）在免疫接种前要求进行体格检查，相比之下，HMO的医生中这一比例为49%，FFS的医生中为56%，没有主要支付来源的医生中为63%（P<0.01）。
执业的主要支付来源似乎会影响主动免疫实践的使用情况。
