Dunn M Kate, Misra Sumi, Habermann Ralf, Griffin Marie R
Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine and Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA.
J Am Med Dir Assoc. 2003 May-Jun;4(3):135-8. doi: 10.1097/01.JAM.0000064462.55083.DC.
To describe the impact of a Tennessee Department of Health regulation amendment requiring that all nursing home residents 65 years of age or older demonstrate documentation of pneumococcal vaccination, or documented medical contraindication, or patient refusal.
Cross-sectional descriptive study of nursing homes using a mailed self-administered survey instrument.
Of 354 Tennessee nursing homes, 304 homes were targeted for the survey, after excluding hospital-based rehabilitation and skilled care facilities, and facilities with fewer than 50 beds. Pneumococcal immunization rates improved from 32% to 42% from 1998 to 1999, coincident with the new policy. Homes reporting high immunization rates (>/=75%) increased from 21% to 28%. These facilities were more likely to be larger (>100 beds) and urban; to have a computerized or chart-based vaccine record; to have a standing order policy; and high influenza immunization rates. Overall, only 23% of homes reported that the policy was helpful in increasing immunization rates, and only 38% of facilities reported an increase in rates of at least 5%. However, 58% of facilities that found the policy useful improved pneumococcal vaccination rates at least 5% compared with 32% that did not find it useful. No other factors were strongly associated with improved vaccine rates.
Pneumococcal immunization rates of at least 75% were associated with facility size, location, and record-keeping practices. Pneumococcal vaccination rates improved only modestly between 1998 and 1999, coincident with the health department amendment. Those who found the policy useful had the greatest improvement in rates.
描述田纳西州卫生部一项法规修正案的影响，该修正案要求所有65岁及以上的养老院居民出示肺炎球菌疫苗接种证明、有记录的医学禁忌证或患者拒绝接种的证明。
使用邮寄的自行填写调查问卷对养老院进行横断面描述性研究。
在田纳西州的354家养老院中，排除医院附属的康复和专业护理机构以及床位少于50张的机构后，有304家养老院被纳入调查对象。与新政策同时，肺炎球菌免疫接种率从1998年的32%提高到了1999年的42%。报告高免疫接种率（≥75%）的养老院从21%增加到了28%。这些机构更可能规模较大（>100张床位）且位于城市；有计算机化或基于图表的疫苗接种记录；有长期医嘱政策；以及流感免疫接种率高。总体而言，只有23%的养老院报告该政策有助于提高免疫接种率，只有38%的机构报告接种率至少提高了5%。然而，认为该政策有用的机构中有58%将肺炎球菌疫苗接种率至少提高了5%，而认为该政策无用的机构这一比例为32%。没有其他因素与疫苗接种率的提高有强烈关联。
至少75%的肺炎球菌免疫接种率与机构规模、位置和记录保存做法有关。1998年至1999年期间，肺炎球菌疫苗接种率仅略有提高，这与卫生部的修正案同时发生。那些认为该政策有用的机构接种率提高幅度最大。
