Klabunde Carrie N, Meissner Helen I, Wooten Karen G, Breen Nancy, Singleton James A
Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
Am J Prev Med. 2007 Jul;33(1):1-8. doi: 10.1016/j.amepre.2007.02.043.
This study examined patterns of use of three adult preventive services-influenza vaccination, pneumococcal polysaccharide vaccination, and colorectal cancer (CRC) screening; factors associated with different use patterns; and reasons for non-use.
Data from 3675 individuals aged 65 and older responding to the 2004 National Adult Immunization Survey, which included a CRC screening module, were analyzed in 2005-2006. Descriptive statistics were used to characterize patterns of use of preventive services, and to assess reasons for non-use. Polytomous logistic regression modeling was used to identify predictors of specific use patterns.
Thirty-seven percent of respondents were current with all three preventive services; 10% were not current with any. Preventive services use varied by demographic and healthcare utilization characteristics. Having a recent visit to a doctor or other health provider was the most consistent predictor of use. Concern about side effects was the most frequently cited reason for not having an influenza vaccination (25%), while not knowing that the preventive service was needed was the most common reason for non-use of pneumonia vaccination (47%) and CRC tests (44% FOBT, 51% sigmoidoscopy, 47% colonoscopy).
Rates of influenza and pneumonia vaccination and CRC screening are suboptimal. This is especially apparent when examining the combined use of these services. Patient and provider activation and the new "Welcome to Medicare" benefit are among the strategies that may improve use of these services among older Americans. Ongoing monitoring and further research are required to determine the most effective approaches.
本研究调查了三种成人预防服务的使用模式——流感疫苗接种、肺炎球菌多糖疫苗接种和结直肠癌（CRC）筛查；与不同使用模式相关的因素；以及未使用的原因。
对2004年全国成人免疫接种调查中3675名65岁及以上个体的数据进行分析，该调查包括一个CRC筛查模块，分析时间为2005 - 2006年。描述性统计用于描述预防服务的使用模式，并评估未使用的原因。多分类逻辑回归模型用于确定特定使用模式的预测因素。
37%的受访者三种预防服务均按时接受；10%的受访者任何一种都未按时接受。预防服务的使用因人口统计学和医疗保健利用特征而异。近期看过医生或其他医疗服务提供者是使用预防服务最一致预测因素。担心副作用是未接种流感疫苗最常提及的原因（25%），而不知道需要接受预防服务是未接种肺炎疫苗（47%）和未进行CRC检测（粪便潜血试验44%、乙状结肠镜检查51%、结肠镜检查47%）最常见的原因。
流感和肺炎疫苗接种率以及CRC筛查率未达最佳水平。在检查这些服务的联合使用情况时尤其明显。患者和医疗服务提供者的积极性以及新的“欢迎加入医疗保险”福利是可能提高美国老年人对这些服务使用率的策略之一。需要持续监测和进一步研究以确定最有效的方法。
