Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
J Am Med Dir Assoc. 2010 Nov;11(9):654-61. doi: 10.1016/j.jamda.2009.12.091. Epub 2010 Aug 5.
Influenza vaccination coverage among nursing home residents has consistently been reported well below the Healthy People goals. We sought to determine if standing order programs (SOPs) in long-term care facilities are associated with greater influenza vaccination coverage among residents.
The National Nursing Home Survey (2004) is cross-sectional. A total of 1152 US long-term care facilities were systematically sampled with probability proportional to number of beds. A total of 11,939 people aged 65 years or older residing in sampled long-term care facilities between August and December 2004 were randomly sampled. Influenza vaccination coverage of residents was obtained from facility records. Facility's immunization program included standing orders versus other (preprinted admission order, advance physician order, personal physician order, and no program). Multinomial logistic regression was used to examine the relationship between type of influenza immunization program and receipt of vaccination, adjusted for resident and facility confounders.
The proportion of residents aged 65 years or older who received influenza vaccination was 64%; 41% of residents lived in a facility with an SOP. Influenza vaccination coverage among residents residing in facilities with standing orders was 68% compared with 59% to 63% of residents in facilities with other program types. Logistic regression showed that standing order programs were independently associated with greater influenza vaccination coverage (66.7% versus 62.0%, P < .01).
This study indicates that residents in long-term care facilities having standing order programs for influenza were more likely to be immunized. More research needs to be done to understand how to facilitate adoption of these programs.
养老院居民的流感疫苗接种率一直远低于“健康人民”目标。我们试图确定长期护理机构中的常规医嘱方案（SOP）是否与居民的流感疫苗接种率更高相关。
国家养老院调查（2004 年）是横断面研究。共有 1152 家美国长期护理机构采用床位比例概率抽样进行系统抽样。2004 年 8 月至 12 月期间，在抽样的长期护理机构中随机抽取了 11939 名年龄在 65 岁或以上的居民。从机构记录中获得居民的流感疫苗接种率。机构的免疫计划包括常规医嘱与其他方案（预印入院医嘱、提前医生医嘱、个人医生医嘱和无计划）。使用多项逻辑回归检验流感免疫计划类型与接种疫苗之间的关系，并调整居民和机构混杂因素。
年龄在 65 岁或以上的居民中，接受流感疫苗接种的比例为 64%；41%的居民居住在有常规医嘱的机构中。有常规医嘱的机构中居民的流感疫苗接种率为 68%，而其他方案类型的机构中居民的接种率为 59%至 63%。逻辑回归显示，常规医嘱方案与更高的流感疫苗接种率独立相关（66.7%比 62.0%，P <.01）。
本研究表明，长期护理机构中常规医嘱方案的居民更有可能接受免疫接种。需要进一步研究如何促进这些方案的采用。
