Koepke C P, Vogel C A, Kohrt A E
Office for Children's Health Policy Research, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Am J Prev Med. 2001 Nov;21(4):250-5. doi: 10.1016/s0749-3797(01)00373-7.
Most studies of immunization behaviors measure adherence to standard immunization practices, relying on surveys without linking reported behaviors to objectively measured immunization rates. This study attempts to close that gap.
In 1997, pediatric, family, and general providers in Pennsylvania serving children aged < 36 months (N = 251) completed immunization behavior surveys. We linked these responses to patient chart audits for practice-level immunization rates.
Immunization rates for our sample fell short of national goals (average up-to-date immunization status at 12 months = 69%). They were significantly higher for pediatricians than for family/general practitioners (78% vs 58%, p < 0.001) and for practices treating > or = 100 children in the past 30 working days than for those treating < 100 children (77% vs 62%, p < 0.001). Behaviors with significant associations to higher immunization coverage were: (1) appropriately giving diphtheria, tetanus toxoids, and pertussis immunization under false contraindications versus withholding it (73% vs 66%, p < 0.05); (2) willingness to give at least four injections at one visit versus fewer injections (74% vs 65%, p < 0.01); and (3) holding immunization in-service training versus no training (71% vs 65%, p < 0.05). However, multivariate analysis showed that only provider specialty remained a significant predictor of coverage.
Pediatricians have higher coverage rates than family/general practitioners. Although pediatricians see more children, the number of immunization-delayed children at 12 months is approximately the same for both provider groups. Therefore, efforts to improve coverage should continue to be directed toward both groups.
大多数免疫行为研究衡量的是对标准免疫做法的依从性，依靠的是调查，而未将报告的行为与客观测量的免疫率联系起来。本研究试图填补这一空白。
1997年，宾夕法尼亚州为36个月以下儿童服务的儿科、家庭和普通医疗服务提供者（N = 251）完成了免疫行为调查。我们将这些回答与用于实践层面免疫率的患者病历审核结果相联系。
我们样本的免疫率未达到国家目标（12个月时的平均最新免疫状况 = 69%）。儿科医生的免疫率显著高于家庭/普通医生（78%对58%，p < 0.001），且在过去30个工作日内治疗100名及以上儿童的医疗机构的免疫率高于治疗不足100名儿童的医疗机构（77%对62%，p < 0.001）。与更高免疫覆盖率有显著关联的行为包括：（1）在存在假禁忌证的情况下适当给予白喉、破伤风类毒素和百日咳免疫接种而非不予接种（73%对66%，p < 0.05）；（2）愿意在一次就诊时给予至少四针注射而非较少针数（74%对65%，p < 0.01）；以及（3）举办免疫在职培训而非不举办培训（71%对65%，p < 0.05）。然而，多变量分析表明，只有医疗服务提供者的专业仍然是覆盖率的显著预测因素。
儿科医生的覆盖率高于家庭/普通医生。尽管儿科医生看诊的儿童更多，但两个医疗服务提供者群体在12个月时免疫接种延迟的儿童数量大致相同。因此，提高覆盖率的努力应继续针对这两个群体。
