透析诊所常备医嘱政策与疫苗接种率的关联：一项基于美国的横断面研究。

Association of standing-order policies with vaccination rates in dialysis clinics: a US-based cross-sectional study.

作者信息

Bond T Christopher, Patel Priti R, Krisher Jenna, Sauls Leighann, Deane Jan, Strott Karen, Karp Shelley, McClellan William

机构信息

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.

出版信息

Am J Kidney Dis. 2009 Jul;54(1):86-94. doi: 10.1053/j.ajkd.2008.12.038. Epub 2009 Apr 5.

DOI:10.1053/j.ajkd.2008.12.038

PMID:19346041

Abstract

BACKGROUND

Patients with end-stage renal disease are at increased risk of morbidity and mortality because of infection. Quality improvement efforts for this patient population include assessment of institutional policies and practices that may increase vaccination rates for influenza, hepatitis B, and pneumococcal disease.

STUDY DESIGN

A survey of vaccination practices, beliefs, and attitudes was sent to all dialysis centers in End-Stage Renal Disease Networks 6, 11, and 15.

SETTING & PARTICIPANTS: Of 1,052 dialysis facilities considered, 683 returned the survey, reported vaccination rates for 2005 to 2006, and had 20 or more patients.

PREDICTOR OR FACTOR

Standing-order policy of the dialysis facility, categorized as facility-wide orders, preprinted admission orders for each patient (chart orders), physician-specific orders, and individual orders.

OUTCOMES

Vaccination rates for influenza, hepatitis B (full or partial series), hepatitis B, and pneumococcal vaccine.

MEASUREMENTS

Patient vaccination, given at or outside the center.

RESULTS

Overall vaccination rates were 76% +/- 18% (SD) for influenza, 73% +/- 22% for hepatitis B full or partial series, 62% +/- 25% for hepatitis B full series, and 44% +/- 34% for pneumococcal vaccine. Compared with individual orders, facility-wide standing orders and chart orders were not associated with greater vaccination rates for influenza (0.4%; confidence interval, -4 to 5; and 1.27%; confidence interval, -3 to 5, respectively), but were associated with greater vaccination rates for hepatitis B full or partial series (9%; confidence interval, 3 to 15; and 11%; confidence interval, 5 to 17, respectively), hepatitis B full series (11%; confidence interval, 4 to 17; and 13%; confidence interval, 7 to 19, respectively), and pneumococcal disease (21%; confidence interval, 14 to 29; and 20%; confidence interval, 13 to 27, respectively).

LIMITATIONS

Data are cross-sectional, and vaccinations outside the center were self-reported.

CONCLUSIONS

Existing facility-wide or chart-based order programs may be effective in promoting vaccination against hepatitis B and pneumococcal disease.

摘要

背景

终末期肾病患者因感染而出现发病和死亡的风险增加。针对这一患者群体的质量改进措施包括评估可能提高流感、乙型肝炎和肺炎球菌疾病疫苗接种率的机构政策和做法。

研究设计

向终末期肾病网络6、11和15中的所有透析中心发送了一份关于疫苗接种做法、信念和态度的调查问卷。

背景与参与者

在1052家被考虑的透析机构中，683家返回了调查问卷，报告了2005年至2006年的疫苗接种率，并且拥有20名或更多患者。

预测因素或因子

透析机构的长期医嘱政策，分为全机构医嘱、每位患者的预印入院医嘱（病历医嘱）、医生特定医嘱和个人医嘱。

结果

流感疫苗接种率、乙型肝炎（全程或部分接种系列）疫苗接种率、乙型肝炎全程疫苗接种率和肺炎球菌疫苗接种率。

测量指标

在透析中心内或中心外进行的患者疫苗接种。

结果

流感疫苗总体接种率为76%±18%（标准差），乙型肝炎全程或部分接种系列疫苗接种率为73%±22%，乙型肝炎全程疫苗接种率为62%±25%，肺炎球菌疫苗接种率为44%±34%。与个人医嘱相比，全机构长期医嘱和病历医嘱与流感疫苗接种率的提高无关（分别为0.4%；置信区间为-4至5；以及1.27%；置信区间为-3至5），但与乙型肝炎全程或部分接种系列疫苗接种率的提高有关（分别为9%；置信区间为3至15；以及11%；置信区间为5至17），乙型肝炎全程疫苗接种率的提高有关（分别为11%；置信区间为4至17；以及13%；置信区间为7至19），以及肺炎球菌疾病疫苗接种率的提高有关（分别为21%；置信区间为14至29；以及20%；置信区间为13至27）。