不同基层医疗办公室环境下成人免疫接种的机会错失情况。

Missed opportunities for adult immunization in diverse primary care office settings.

作者信息

Nowalk Mary Patricia, Zimmerman Richard K, Feghali Joyce

机构信息

Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, 3518 Fifth Avenue, Pittsburgh, PA 15261, USA.

出版信息

Vaccine. 2004 Sep 3;22(25-26):3457-63. doi: 10.1016/j.vaccine.2004.02.022.

DOI:10.1016/j.vaccine.2004.02.022

PMID:15308372

Abstract

Adult vaccination rates are well below national goals of 90%. We examined medical records of 810 adults > or =65 years to determine number and type of visits, discussion and patient refusals of vaccines, influenza vaccinations over three seasons, and pneumococcal and tetanus vaccinations over 5 years. From the medical record, immunization rates were 24.1% for annual influenza, 49.1% for pneumococcal polysaccharide and 28.6% for tetanus vaccine. During the 27 month study period, patients averaged 1.3 +/- 1.9 acute visits, 6.9 +/- 5.1 chronic visits and 0.48 +/- 0.91 preventive visits (mean +/- S.D.). Missed opportunities to vaccinate ranged from 38.4 to 94.5% of visits. Vaccination rates were higher if medical records included health maintenance flow sheets. Failure to discuss vaccination, to vaccinate at acute care visits, and low frequency of preventive visits resulted in missed opportunities to vaccinate. A health maintenance flow sheet can prompt providers to discuss vaccination and record vaccines as they are administered.

摘要

成人疫苗接种率远低于90%的国家目标。我们检查了810名年龄≥65岁成年人的病历，以确定就诊次数和类型、关于疫苗接种的讨论以及患者拒绝接种疫苗的情况，三个季节的流感疫苗接种情况，以及五年内的肺炎球菌疫苗和破伤风疫苗接种情况。根据病历，年度流感疫苗接种率为24.1%，肺炎球菌多糖疫苗接种率为49.1%，破伤风疫苗接种率为28.6%。在为期27个月的研究期间，患者平均进行1.3±1.9次急性病就诊、6.9±5.1次慢性病就诊和0.48±0.91次预防性就诊（均值±标准差）。错过的疫苗接种机会占就诊次数的38.4%至94.5%。如果病历中包含健康维护流程表，疫苗接种率会更高。未能讨论疫苗接种、在急症就诊时未进行疫苗接种以及预防性就诊频率较低导致了错过疫苗接种机会。健康维护流程表可以促使医护人员在接种疫苗时讨论疫苗接种情况并记录接种的疫苗。