在初级保健中错失为老年人接种疫苗的机会。

Missed opportunities to vaccinate older adults in primary care.

作者信息

Nowalk Mary Patricia, Zimmerman Richard Kent, Cleary Stephanie M, Bruehlman Richard D

机构信息

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

出版信息

J Am Board Fam Pract. 2005 Jan-Feb;18(1):20-7. doi: 10.3122/jabfm.18.1.20.

DOI:10.3122/jabfm.18.1.20

PMID:15709060

Abstract

OBJECTIVE

During the 2000 to 2001 influenza season, distribution of influenza vaccine was delayed, and national self-reported vaccination rates declined. The purposes of this study were to characterize missed opportunities for adult vaccinations and assess the impact of the vaccine delay on missed opportunities for influenza vaccination as recorded in medical records.

METHODS

In a cross-sectional analysis, medical record data from 217 adult patients aged > or =65 years in primary care practices that received influenza vaccine supplies late in 2000 were used to assess rates and missed opportunities to vaccinate. Missed opportunities were defined as visits in which there was no record that vaccine had been given, discussed, or refused by the patient.

RESULTS

During the mean study period of 37.1 +/- 5.7 months, patients averaged 12.1 +/- 5.9 visits to their primary care physician's office. Medical records indicated that 75% of patients had received pneumococcal polysaccharide vaccine (PPV) and 30% had received tetanus toxoid from 1991 to 2001; 81% had received at least one influenza vaccine in the previous 4 seasons. During the 2000 to 2001 influenza season, influenza vaccination rates declined significantly to 41% from 57% in 1999 to 2000. Overall missed opportunities to vaccinate during the study period averaged 3.4 +/- 3.0 for influenza vaccine, 10.7 +/- 7.3 for pneumococcal vaccine, and 10.8 +/- 5.9 for tetanus toxoid. During the delay season, the number of visits increased, but missed opportunities to vaccinate also increased significantly, even after vaccine supplies had been received.

CONCLUSIONS

Missed opportunities to vaccinate occur frequently and vaccine shortages create additional challenges to adult vaccination. Missed opportunities may be minimized and maintenance of accurate adult immunization records may be achieved by assessing and recording vaccination status at each visit, regardless of vaccine availability. By so doing, providers can easily convey the message to their patients that immunizations are an important part of their care.

摘要

目的

在2000至2001年流感季节，流感疫苗的分发出现延迟，全国自我报告的疫苗接种率下降。本研究的目的是描述成人疫苗接种错失机会的特征，并评估疫苗延迟对病历中记录的流感疫苗接种错失机会的影响。

方法

在一项横断面分析中，使用了2000年后期才收到流感疫苗供应的初级保健机构中217名年龄≥65岁成年患者的病历数据，以评估疫苗接种率和错失机会。错失机会被定义为没有记录显示患者接种、讨论或拒绝接种疫苗的就诊情况。

结果

在平均37.1±5.7个月的研究期间，患者平均到初级保健医生办公室就诊12.1±5.9次。病历显示，在1991年至2001年期间，75%的患者接种了肺炎球菌多糖疫苗（PPV），30%的患者接种了破伤风类毒素；81%的患者在之前4个季节中至少接种过一次流感疫苗。在2000至2001年流感季节，流感疫苗接种率从1999至2000年的57%显著降至41%。在研究期间，流感疫苗接种的总体错失机会平均为3.4±3.0次，肺炎球菌疫苗为10.7±7.3次，破伤风类毒素为10.8±5.9次。在延迟季节，就诊次数增加，但即使在收到疫苗供应后，接种错失机会也显著增加。