Columbia University, Division of General Pediatrics, New York, NY 10032, USA.
Public Health Rep. 2011 Jul-Aug;126 Suppl 2(Suppl 2):24-32. doi: 10.1177/00333549111260S204.
Little is known about how families' experiences with immunization visits within the medical home may affect children's immunization status. We assessed the association between families' negative immunization experiences within the medical home and underimmunization.
We surveyed parents (n = 392) of children aged 2-36 months about immunization experiences at community health centers, hospital-based clinics, private practices, and community-based organizations in New York City. We used Chi-square tests and odds ratios (ORs) to assess the relationship between medical home elements and parental immunization experience ratings. We used multivariable analysis to determine the association between negative experiences during immunization visits and underimmunization, controlling for insurance, maternal education, and receipt of benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children.
The majority of children were of Latino race/ethnicity and had Medicaid and a medical home. One-sixth (16.9%) of families reported a previous negative immunization experience, primarily related to the child's reaction, waiting time, and attitudes of medical and office staff. Parents' negative immunization experiences were associated with the absence of four components of the medical home: continuity of care, family-centered care, compassionate care, and comprehensive care. In addition, children in families who reported a negative experience were more likely to have been underimmunized (adjusted OR = 2.00; 95% confidence interval 1.12, 3.58).
In a community in New York City, underimmunization of young children was associated with negative immunization experiences. Strategies to improve family experiences with immunization visits within the medical home (particularly around support for the family), medical and ancillary staff attitudes, and reduced waiting time may lead to improved immunization delivery.
对于家庭在医疗之家的免疫接种体验如何影响儿童的免疫状况，我们知之甚少。我们评估了家庭在医疗之家的负面免疫体验与免疫不足之间的关联。
我们调查了纽约市社区卫生中心、医院诊所、私人诊所和社区组织的 392 名 2-36 个月大儿童的父母，了解其免疫接种经历。我们使用卡方检验和优势比（OR）来评估医疗之家要素与父母免疫体验评分之间的关系。我们使用多变量分析来确定免疫接种期间负面体验与免疫不足之间的关联，同时控制保险、母亲教育和特殊补充营养计划妇女、婴儿和儿童福利的获取。
大多数儿童为拉丁裔，拥有医疗补助和医疗之家。六分之一（16.9%）的家庭报告了以前的负面免疫体验，主要与儿童的反应、等待时间以及医疗和办公室工作人员的态度有关。父母的负面免疫体验与医疗之家的四个组成部分缺失有关：连续护理、以家庭为中心的护理、有同情心的护理和全面护理。此外，报告负面体验的家庭的儿童更有可能免疫不足（调整后的 OR = 2.00；95%置信区间 1.12，3.58）。
在纽约市的一个社区中，幼儿免疫不足与负面免疫体验有关。改善家庭在医疗之家的免疫接种体验（特别是围绕对家庭的支持）、医疗和辅助人员态度以及减少等待时间的策略可能会改善免疫接种的提供。
