Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Ann Fam Med. 2009 Nov-Dec;7(6):534-41. doi: 10.1370/afm.1060.
Vaccination rates for pneumococcal polysaccharide vaccine (PPV) and influenza vaccine are relatively low in disadvantaged urban populations. This study was designed to assess which physician and practice characteristics might explain differences in rates across physicians.
PPV and influenza vaccination rates were determined for 2,021 patients aged 65 years and older receiving care from 30 physicians in 17 practices surveyed about their office systems for providing adult immunizations. Hierarchical linear modeling (HLM) analyses were used to examine the relationships among vaccination rates, patient-level characteristics, and physician variables.
Overall, the weighted PPV vaccination rate was 60.0% and varied widely across physicians (range, 11%-98%). At the patient level in HLM, patient race (P=.01) and age (P = .02), but not neighborhood income, were associated with PPV status. By linking physician survey data with PPV rates, we found the best pair of physician variables to be "reported time spent with patients for a well visit" (P = .01) and "use of enhanced immunization documentation" (P=.10). The overall influenza vaccination rate was 51.9% (range, 22%-96%). Patient race (P=.003) and age (P = .002) were associated with influenza vaccination. The pair of physician variables with the strongest association with influenza vaccination was "use of standing orders" (P <.001) and "average observed physician examination room time," regardless of visit type (P=.02).
Vaccination rates vary widely in urban settings and are associated with practice characteristics such as time spent with patients and, for influenza vaccine, use of standing orders.
在处于不利地位的城市人群中，肺炎球菌多糖疫苗（PPV）和流感疫苗的接种率相对较低。本研究旨在评估哪些医生和实践特征可能解释了医生之间的差异。
对 2021 名年龄在 65 岁及以上的患者进行了 PPV 和流感疫苗接种率的评估，这些患者来自 17 个接受调查的实践中的 30 名医生，调查了他们提供成人免疫接种的办公室系统。使用分层线性模型（HLM）分析来检查接种率、患者水平特征和医生变量之间的关系。
总体而言，加权 PPV 疫苗接种率为 60.0%，且在医生之间差异很大（范围为 11%-98%）。在 HLM 中的患者水平上，患者种族（P=.01）和年龄（P=.02），而不是邻里收入，与 PPV 状况相关。通过将医生调查数据与 PPV 率联系起来，我们发现最佳的医生变量组合是“报告用于一次就诊的患者就诊时间”（P=.01）和“使用增强型免疫记录”（P=.10）。整体流感疫苗接种率为 51.9%（范围为 22%-96%）。患者种族（P=.003）和年龄（P=.002）与流感疫苗接种相关。与流感疫苗接种关联最强的医生变量组合是“使用常规医嘱”（P<0.001）和“平均观察医生诊室时间”，无论就诊类型如何（P=.02）。
在城市环境中，疫苗接种率差异很大，并且与实践特征相关，例如与患者的相处时间，以及对于流感疫苗，使用常规医嘱。
