Goldfarb Neil I, Patel Nikita M, Clarke Janice L
Department of Health Policy, Jefferson Medical College, Philadelphia, USA.
Manag Care. 2005 Jun;14(6 Suppl):3-12.
In the last 4 decades, the number of diseases that vaccines can prevent has quadrupled, and, correspondingly, so has the number of immunizations that is to be administered before a child's second birthday. Based on current recommendations, a child may receive as many as six vaccine injections in a single visit. Vaccine technology has advanced significantly since the introduction of the first combination vaccine, diphtheria-tetanus (DT), in the 1950s. In the United States today, as many as five antigens can be administered in a single injection, and additional combination vaccines are in the pipeline. Increasing the number of antigens delivered with a single injection minimizes physical discomfort for the child, reduces associated stress for the parent, saves time for the provider, and is likely to improve vaccine coverage and timeliness of administration rates. While national immunization guidelines from the Centers for Disease Control and Prevention call for use of combination vaccines where available, provider and parent perceptions can act as barriers to their optimal use. Managed care organizations (MCOs) have the opportunity to improve quality of care and immunization rates by educating providers on the use of combination vaccines in accordance with the national guidelines. This article examines the evidence for pediatric combination vaccines, discusses barriers to their use among parents and providers, presents quality and cost implications of a managed care policy to broaden their use, and suggests ways in which MCOs can more actively promote appropriate use of combination vaccines by providers.
在过去40年里，疫苗可预防疾病的数量翻了两番，相应地，儿童在两岁生日前需要接种的疫苗数量也增加了两倍。根据目前的建议，儿童一次就诊可能要接种多达六种疫苗。自20世纪50年代第一种联合疫苗白喉-破伤风（DT）问世以来，疫苗技术有了显著进步。如今在美国，一次注射中可接种多达五种抗原，还有更多联合疫苗正在研发中。增加单次注射的抗原数量可将儿童的身体不适降至最低，减轻家长的相关压力，为医护人员节省时间，还可能提高疫苗接种覆盖率和接种及时性。虽然疾病控制与预防中心的国家免疫指南提倡在可行的情况下使用联合疫苗，但医护人员和家长的观念可能会阻碍联合疫苗的最佳使用。管理式医疗组织（MCO）有机会通过按照国家指南对医护人员进行联合疫苗使用方面的教育，来提高医疗质量和疫苗接种率。本文审视了儿科联合疫苗的相关证据，讨论了家长和医护人员使用联合疫苗的障碍，介绍了扩大联合疫苗使用的管理式医疗政策对质量和成本的影响，并提出了MCO可更积极促进医护人员合理使用联合疫苗的方法。
