Davis Terry C, Fredrickson Doren D, Bocchini Claire, Arnold Connie L, Green Kristen W, Humiston Sharon G, Wilder Errol, Bocchini Joseph A
Louisiana State University Health Sciences Center-Shreveport, Department of Pediatrics, 71130, USA.
Ambul Pediatr. 2002 May-Jun;2(3):193-200. doi: 10.1367/1539-4409(2002)002<0193:ivrbcw>2.0.co;2.
The National Childhood Vaccine Injury Act (NCVIA) requires that physicians distribute the appropriate Vaccine Information Statements (VIS) at each immunization visit and discuss the risks/benefits of every vaccine given. In a national study, 31% of pediatricians reported not using the VIS and 56% indicated that time was a barrier to vaccine risk/benefit communication. Parents, however, indicated they want their primary providers to personally tell them about risks/benefits.
To test the feasibility of an Immunization Education Package (IEP) intervention to improve compliance with the federal mandate and to improve physician/parent vaccine risk/benefit communication.
Two multi-physician private pediatric practices in Shreveport, La.
A before-after trial with comparison of 130 pre-intervention and 78 post-intervention visits. Research assistants recorded content and duration of immunization discussions during well-baby visits during which immunizations were scheduled. Clinic staffs were masked as to variables recorded.
The IEP was a multifaceted intervention, involving a practice-based in-service and distribution and discussion of ready-to-use materials including an exam room poster entitled "7 Questions Parents Need To Ask About Baby Shots."
Patients were 90% white and 96% privately insured. Pre and post results revealed a significant increase in VIS distribution (33% vs 91%, P <.001) and physician and nurse initiation of verbal teaching about the vaccine (65% vs 100%, 32% vs 72%, respectively; P <.001 for both), and parent initiation of questions (0% vs 32%, P <.001). A significant increase was found in the discussion of 6 of 8 major immunization IEP topics: contraindications, common side effects, treatment of common side effects, severe side effects, management of severe side effects, and schedule of the next vaccination. These vaccine communication improvements were made with a very small (20-s) increase in physician time. In post-intervention focus groups, provider staff endorsed the IEP method.
This IEP was a feasible way to facilitate compliance with the NCVIA. A significant amount of additional information was provided to parents with only a slight increase in time.
《国家儿童疫苗伤害法案》（NCVIA）要求医生在每次免疫接种就诊时发放适当的疫苗信息声明（VIS），并讨论每种所接种疫苗的风险/益处。在一项全国性研究中，31%的儿科医生报告未使用VIS，56%的医生表示时间是疫苗风险/益处沟通的障碍。然而，家长们表示希望他们的初级医疗服务提供者亲自告知他们风险/益处。
测试免疫教育包（IEP）干预措施在提高联邦规定的依从性以及改善医生/家长之间疫苗风险/益处沟通方面的可行性。
路易斯安那州什里夫波特市的两家拥有多名医生的私人儿科诊所。
一项前后对照试验，比较130次干预前就诊和78次干预后就诊情况。研究助理记录了在安排免疫接种的健康婴儿就诊期间免疫接种讨论的内容和时长。诊所工作人员对所记录的变量不知情。
IEP是一项多方面的干预措施，包括基于诊所的在职培训以及分发和讨论即用型材料，其中包括一张诊室海报，标题为“家长关于婴儿疫苗接种需问的7个问题”。
患者中90%为白人，96%拥有私人保险。干预前后的结果显示，VIS发放量显著增加（33%对91%，P<.001），医生和护士开始进行疫苗口头教学的比例也显著增加（分别为65%对100%，32%对72%；两者P均<.001），家长开始提问的比例也显著增加（0%对32%，P<.001）。在8个主要免疫IEP主题中的6个主题的讨论中发现显著增加：禁忌证、常见副作用、常见副作用的治疗、严重副作用、严重副作用的处理以及下次疫苗接种时间表。这些疫苗沟通方面的改善仅使医生的时间增加了很少一部分（20秒）。在干预后的焦点小组中，医疗服务提供者工作人员认可IEP方法。
这种IEP是促进遵守NCVIA的一种可行方式。在时间仅稍有增加的情况下，向家长提供了大量额外信息。
