Zimmerman Richard Kent, Nowalk Mary Patricia, Bardella Inis J, Fine Michael J, Janosky Janine E, Santibanez Tammy A, Wilson Stephen A, Raymund Mahlon
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Am J Prev Med. 2004 Jan;26(1):1-10. doi: 10.1016/j.amepre.2003.09.020.
Influenza vaccination rates among adults, especially in minority populations, remain below national goals of 90%. This study investigated in diverse settings, facilitators of and barriers to patient influenza vaccination from the physician's perspective.
Two-stage, stratified, random-cluster sampling was employed to select 71 clinicians from inner-city, rural, suburban, and Veterans Affairs (VA) practices, and a random sample of 925 of their patients aged >/=65 years. Questionnaires and interviews based on the PRECEDE-PROCEED framework assessed clinician factors. Associations among clinician beliefs, practice characteristics, patient beliefs, and self-reported influenza vaccination status were determined.
The clinician response rate was 85% (60/71). Several factors of the PRECEDE-PROCEED framework were associated with higher influenza vaccination rates. For instance, patients at practices with express vaccination clinics had higher vaccination rates than at clinics without such immunization programs (87% v 76%, p =0.01). Using multivariate models, influenza vaccination status was related to several patient factors, including plans to receive influenza vaccination next year (p <0.001); belief that those who are not vaccinated will contract influenza (p =0.049); and history of being screened for colon cancer (p =0.023). Influenza vaccination status was also related to several physician factors, including awareness of recommendation to vaccinate asthmatics (p =0.024); agreement with these recommendations (p =0.004); and practice type and setting ("strata"), of which the VA was highest.
Through proactive office systems and education, physicians may influence patients' intentions to be vaccinated and thereby increase influenza vaccination rates.
成人流感疫苗接种率，尤其是少数族裔人群的接种率，仍低于90%的国家目标。本研究从医生的角度，在不同环境中调查了患者流感疫苗接种的促进因素和障碍。
采用两阶段分层随机整群抽样法，从市中心、农村、郊区和退伍军人事务（VA）医疗机构中选取71名临床医生，并从他们年龄≥65岁的患者中随机抽取925名作为样本。基于PRECEDE-PROCEED框架的问卷和访谈评估了临床医生因素。确定了临床医生信念、执业特征、患者信念与自我报告的流感疫苗接种状况之间的关联。
临床医生的回复率为85%（60/71）。PRECEDE-PROCEED框架的几个因素与较高的流感疫苗接种率相关。例如，设有快速接种门诊的医疗机构的患者接种率高于没有此类免疫计划的诊所（87%对76%，p =0.01）。使用多变量模型，流感疫苗接种状况与几个患者因素有关，包括明年接种流感疫苗的计划（p<0.001）；认为未接种疫苗者会感染流感的信念（p =0.049）；以及结肠癌筛查史（p =0.023）。流感疫苗接种状况还与几个医生因素有关，包括对哮喘患者接种建议的知晓情况（p =0.024）；对这些建议的认同（p =0.004）；以及执业类型和环境（“分层”），其中VA医疗机构的接种率最高。
通过积极的办公系统和教育，医生可以影响患者的接种意愿，从而提高流感疫苗接种率。
