Nichol K L, Zimmerman R
Center for Chronic Disease Outcomes Research, VA Medical Center, One Veterans Drive, Minneapolis, MN 55417, USA.
Arch Intern Med. 2001;161(22):2702-8. doi: 10.1001/archinte.161.22.2702.
Influenza and pneumococcal vaccination rates remain too low. This survey assessed generalist and subspecialist physicians' knowledge, attitudes, and practices regarding influenza and pneumococcal vaccinations for high-risk patients.
A self-administered questionnaire was mailed to 6000 physicians randomly selected from a national database.
After 3 mailings, 1874 physicians (32%) of the 5858 eligible responded. Although most physicians thought that it was very important for their high-risk patients be current on influenza and pneumococcal vaccinations, only 86% and 75% of generalists and subspecialists, respectively, very strongly recommended influenza vaccinations to their elderly patients and only 81% and 64%, respectively, very strongly recommended pneumococcal vaccinations to their elderly patients (P<.001 for both). After multivariate logistic regression, factors significantly associated with strongly recommending vaccinations to elderly patients in the influenza and pneumococcal vaccination models included female sex of provider, the provider having received an influenza vaccination, the provider's beliefs about vaccine effectiveness and cost-effectiveness, a patient's risk for illness, and ease of targeting patients. In addition, generalists were more likely than subspecialists to strongly recommend pneumococcal vaccinations to their patients. Patient reminders, special clinics, and standing orders were each used by fewer than 30% of respondents, although generalists were more likely than subspecialists to use such strategies.
Nontrivial proportions of generalist and subspecialist physicians fail to strongly recommend influenza and pneumococcal vaccinations to their elderly and high-risk patients. Other effective strategies for promoting vaccine delivery are also used relatively infrequently. These findings suggest areas for improvement if vaccination rates are to reach national goals.
流感疫苗和肺炎球菌疫苗的接种率仍然过低。本调查评估了普通科和专科医生对于高危患者流感疫苗和肺炎球菌疫苗接种的知识、态度及行为。
向从全国数据库中随机抽取的6000名医生邮寄了一份自填式问卷。
经过三轮邮寄，5858名符合条件的医生中有1874名（32%）回复。尽管大多数医生认为高危患者及时接种流感疫苗和肺炎球菌疫苗非常重要，但分别只有86%的普通科医生和75%的专科医生向老年患者强烈推荐流感疫苗，向老年患者强烈推荐肺炎球菌疫苗的分别只有81%和64%（两者P<0.001）。多因素逻辑回归分析显示，在流感疫苗和肺炎球菌疫苗接种模型中，与向老年患者强烈推荐疫苗显著相关的因素包括医生为女性、医生接种过流感疫苗、医生对疫苗有效性和成本效益的看法、患者的患病风险以及确定目标患者的难易程度。此外，普通科医生比专科医生更有可能向患者强烈推荐肺炎球菌疫苗。不到30%的受访者使用患者提醒、开设专门诊所和长期医嘱等方式，不过普通科医生比专科医生更有可能采用这些策略。
相当比例的普通科和专科医生未能向老年及高危患者强烈推荐流感疫苗和肺炎球菌疫苗。其他促进疫苗接种的有效策略使用频率也相对较低。这些发现提示了若要实现全国疫苗接种目标有待改进的方面。
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