Schaffer Stanley J, Fontanesi John, Rickert Donna, Grabenstein John D, Rothholz Mitchel C, Wang Susan A, Fishbein Daniel
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
Pediatrics. 2008 Jan;121 Suppl 1:S35-45. doi: 10.1542/peds.2007-1115E.
Our goal was to evaluate the capacity of various health care settings to supplement the activities of the traditional medical home by delivering vaccines to adolescents.
A group of experts in the fields of adolescent-immunization delivery and the provision of preventive care in various health care settings summarized the available literature, considered setting-specific factors, and assessed the ability of various health care settings beyond the traditional medical home to conform to the immunization quality standards set by the National Vaccine Advisory Committee, report vaccination information for the quantitative assessment of vaccine-coverage rates, be likely to offer vaccines to adolescents, and be viewed by adolescents as acceptable sites for receiving vaccinations.
Seven candidate settings were evaluated: pharmacies, obstetrics-gynecology practices, sexually transmitted disease clinics, hospital emergency departments, family planning clinics, teen clinics, and local public health department immunization clinics. The panel concluded that all could safely provide vaccinations to adolescents but that vaccination efforts at some of the settings could potentially have a markedly greater impact on overall adolescent-immunization rates than could those at other settings. In addition, for adolescent-vaccination services to be practical, candidate settings need to have a clear interest in providing them. Conditional on that, several issues need to be addressed: (1) funding; (2) orienting facilities to provide preventive care services; (3) enhancing access to immunization registries; and (4) clarifying issues related to immunization consent.
With supporting health policy, health education, and communication, health care settings beyond the traditional medical home have the potential to effectively augment the vaccination efforts of more traditional settings to deliver vaccines to adolescents. These health care settings may be particularly well suited to reach adolescents who lack access to traditional sources of preventive medical care or receive fragmented medical care.
我们的目标是评估各种医疗保健机构通过为青少年接种疫苗来补充传统医疗之家活动的能力。
一组青少年免疫接种及各种医疗保健机构提供预防保健领域的专家总结了现有文献，考虑了特定机构因素，并评估了传统医疗之家以外的各种医疗保健机构符合国家疫苗咨询委员会制定的免疫接种质量标准、报告疫苗接种信息以进行疫苗接种覆盖率定量评估、可能为青少年提供疫苗以及被青少年视为可接受的疫苗接种场所的能力。
评估了七个候选机构：药房、妇产科诊所、性传播疾病诊所、医院急诊科、计划生育诊所、青少年诊所和当地公共卫生部门免疫接种诊所。专家小组得出结论，所有这些机构都可以安全地为青少年提供疫苗接种，但其中一些机构的疫苗接种工作对总体青少年免疫接种率的潜在影响可能明显大于其他机构。此外，要使青少年疫苗接种服务切实可行，候选机构需要对提供此类服务有明确兴趣。在此前提下，需要解决几个问题：（1）资金；（2）使机构具备提供预防保健服务的能力；（3）加强对免疫接种登记系统的访问；（4）澄清与免疫接种同意相关的问题。
在卫生政策、健康教育和宣传的支持下，传统医疗之家以外的医疗保健机构有可能有效增强更传统机构为青少年接种疫苗的工作力度。这些医疗保健机构可能特别适合接触那些无法获得传统预防医疗服务来源或接受零散医疗服务的青少年。
