Kempe Allison, Hurley Laura, Stokley Shannon, Daley Matthew F, Crane Lori A, Beaty Brenda L, Dickinson L Miriam, Babbel Christine, Barrow Jennifer, Steiner John F
Department of Pediatrics, University of Colorado Denver, Denver, CO, USA.
J Gen Intern Med. 2008 Dec;23(12):2010-3. doi: 10.1007/s11606-008-0800-0. Epub 2008 Oct 2.
Pneumococcal vaccine (PPV) is recommended for adults >or=65 years and those with chronic illness, but there are potential advantages of universal vaccination of adults age 50-64 years.
To assess reported (1) recommendations and administration practices of general internists for PPV, (2) barriers to vaccination, and (3) willingness to expand vaccination to all adults >or=50 years.
National survey of general internists representative of the American College of Physicians.
Response rate was 74% (N = 326). Although 99% reported giving PPV, less than 20% used a computerized database to identify eligible patients by age or diagnoses and only 6% recalled patients. Major barriers included acute problems taking precedence over preventive care (39%), difficulty determining vaccination history (30%), not thinking of it/not a priority (20%), and inadequate reimbursement for vaccine (19%). If ACIP expanded recommendations, 60% would definitely and 37% would probably institute this change.
Most general internists reported giving PPV, but delivery was hindered by competing demands, lack of systems to identify patients needing vaccination, and reimbursement issues. Barriers might be decreased by a policy of universal vaccination of adults >or=50 years, and the majority of physicians reported they would follow such a recommendation if it were made.
肺炎球菌疫苗（PPV）推荐用于65岁及以上的成年人以及患有慢性病的人群，但对50 - 64岁的成年人进行普遍接种可能具有潜在优势。
评估普通内科医生报告的（1）PPV的推荐及接种实践，（2）接种的障碍，以及（3）将接种范围扩大至所有50岁及以上成年人的意愿。
对代表美国医师协会的普通内科医生进行全国性调查。
回复率为74%（N = 326）。尽管99%的医生报告接种过PPV，但不到20%的医生使用计算机数据库按年龄或诊断来确定符合条件的患者，只有6%的医生能记起患者情况。主要障碍包括急性问题优先于预防保健（39%）、难以确定接种史（30%）、未考虑到或不是优先事项（20%）以及疫苗报销不足（19%）。如果美国免疫实践咨询委员会（ACIP）扩大推荐范围，60%的医生肯定会且37%的医生可能会实施这一改变。
大多数普通内科医生报告接种过PPV，但由于需求竞争、缺乏识别需要接种疫苗患者的系统以及报销问题，接种工作受到阻碍。对50岁及以上成年人进行普遍接种的政策可能会减少障碍，并且大多数医生报告如果有这样的推荐，他们会遵循。
