Rickert Donna, Santoli Jeanne, Shefer Abigail, Myrick Angela, Yusuf Hussain
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Am J Prev Med. 2006 Feb;30(2):111-8. doi: 10.1016/j.amepre.2005.10.016.
Despite a longstanding national recommendation to administer influenza vaccine to children at high risk for disease complications, physicians' adherence remains low. This study evaluated physicians' perspectives on previously documented and persistent under-utilization of influenza vaccine for high-risk children.
A cross-sectional survey mailed in 2001-2002 to a nationally representative sample of 1460 U.S. physicians in four key medical specialties. The primary outcome was whether the physician provided annual influenza vaccine to children with asthma or other cardiopulmonary diseases. The hypothesis was that factors predicting reported use would fall into four categories: (1) physician knowledge, (2) physician endorsement of recommendation, (3) perceived barriers, and (4) practice patterns.
The overall response rate was 55% (n=600), but differed by specialty. Most physicians were knowledgeable about the recommendation, but collectively tended to overestimate their own achievements in immunizing high-risk children. Adherence varied by physician specialty, endorsement of recommendation, perceived barriers (including difficulty identifying subpopulations of high-risk children and confusion about who should vaccinate those receiving care from multiple providers), and under-utilization of strategies known to improve vaccination rates.
Better communication strategies are needed to resolve confusion about providing influenza vaccine to high-risk children in subspecialty settings. Because of the difficulties in selectively identifying high-risk patient subgroups, research is needed to assist in putting support strategies into practice. Findings from research in promising areas of practice-based quality improvement may be particularly applicable.
尽管国家长期建议为有疾病并发症高风险的儿童接种流感疫苗，但医生的依从性仍然很低。本研究评估了医生对于此前记录的、持续存在的高危儿童流感疫苗使用不足情况的看法。
2001 - 2002年向美国四个主要医学专科的1460名具有全国代表性的医生样本邮寄了一份横断面调查问卷。主要结果是医生是否为患有哮喘或其他心肺疾病的儿童提供年度流感疫苗。假设是预测报告使用情况的因素将分为四类：（1）医生知识，（2）医生对建议的认可，（3）感知到的障碍，以及（4）实践模式。
总体回复率为55%（n = 600），但因专科不同而有所差异。大多数医生了解该建议，但总体上倾向于高估自己在为高危儿童接种疫苗方面的成就。依从性因医生专科、对建议的认可、感知到的障碍（包括难以识别高危儿童亚群体以及对谁应为从多个提供者处接受治疗的儿童接种疫苗存在困惑）以及已知可提高疫苗接种率的策略使用不足而有所不同。
需要更好的沟通策略来解决在专科环境中为高危儿童提供流感疫苗方面的困惑。由于难以选择性地识别高危患者亚组，需要开展研究以协助将支持策略付诸实践。基于实践的质量改进的有前景领域的研究结果可能特别适用。
