Nowalk Mary Patricia, Bardella Inis Jane, Zimmerman Richard Kent, Shen Shunhua
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
Am J Manag Care. 2004 Jan;10(1):13-9.
To determine which office and patient factors affect adult influenza and pneumococcal vaccination rates.
Patient interviews and self-administered surveys of office managers.
In a 2-stage random cluster sample, 22 practices in 4 strata (Veterans' Affairs, rural, urban/suburban, and inner city) and 15 patients per physician in each practice (n = 946) were selected. Office managers completed a questionnaire regarding office practices and logistics affecting immunizations. Data were examined using chi2 and regression analyses without and with patient factors in the models.
Practice factors significantly related to influenza vaccination status were stratum (VA OR = 2.04; 95% CI = 1.18, 3.53; P < .05 vs inner-city), time allotted for acute care visits (16-20 min vs 10-15 min OR = 2.49; 95% CI = 1.68, 3.09; P < .001), the practice not having a source of free vaccines (OR = .43; 95% CI = .3, .62; P < .001), and the interaction between being an urban/suburban practice and having a source of free flu vaccines (OR = 4.0; 95% CI = 2.63, 6.09; P < .001). Practice factors related to pneumococcal vaccination status were the number of immunization promotion activities (> or = 3 vs 0-2 OR = 1.97; 95% CI = 1.33, 2.94; P = .002) and the time allotted for acute care visits (16-20 min vs 10-15 min OR = 1.94; 95% CI = 1.18, 3.19; P = .011). When practice and patient factors were combined in the analyses, patient factors were more important.
Although patient factors are more important than practice factors, practices that allot more time for acute care visits and use more immunization promotion activities have higher vaccination rates.
确定哪些诊所因素和患者因素会影响成人流感和肺炎球菌疫苗接种率。
对诊所管理人员进行患者访谈和自行填写的调查问卷。
采用两阶段随机整群抽样，从4个层次（退伍军人事务部、农村、城市/郊区和市中心）中选取22个医疗机构，每个医疗机构中每位医生选取15名患者（n = 946）。诊所管理人员完成一份关于影响免疫接种的诊所操作和后勤情况的问卷。在模型中分别使用有无患者因素的卡方检验和回归分析对数据进行检验。
与流感疫苗接种状况显著相关的诊所因素包括层次（退伍军人事务部：比值比[OR]=2.04；95%置信区间[CI]=1.18，3.53；与市中心相比，P<.05）、急性病就诊时间（16 - 20分钟与10 - 15分钟相比：OR = 2.49；95%CI = 1.68，3.09；P<.001）、诊所没有免费疫苗来源（OR =.43；95%CI =.3，.62；P<.001），以及城市/郊区诊所与有免费流感疫苗来源之间的交互作用（OR = 4.0；95%CI = 2.63，6.09；P<.001）。与肺炎球菌疫苗接种状况相关的诊所因素包括免疫接种推广活动的次数（≥3次与0 - 2次相比：OR = 1.97；95%CI = 1.33，2.94；P =.002）和急性病就诊时间（16 - 20分钟与10 - 15分钟相比：OR = 1.94；95%CI = 1.18，3.19；P =.011）。当在分析中综合考虑诊所因素和患者因素时，患者因素更为重要。
虽然患者因素比诊所因素更重要，但为急性病就诊分配更多时间并开展更多免疫接种推广活动的诊所，其疫苗接种率更高。
