Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland.
J Clin Rheumatol. 2012 Aug;18(5):237-41. doi: 10.1097/RHU.0b013e3182611547.
Patients with inflammatory arthritis are at increased risk of infection. Much of the burden of infection in this population is vaccine preventable. A number of international rheumatology organizations have published expert recommendations for vaccination in adult patients. Despite this, reported vaccination rates remain low among patients with inflammatory arthritis.
We sought to establish the knowledge, attitudes, and clinical practice of rheumatologists with respect to vaccination.
Rheumatologists practicing in Ireland in 2009 were surveyed by postal questionnaire. Data collected was entered into Microsoft Excel and statistical analysis was carried out using SPSS18 software.
Eighty (100%) practicing rheumatologists were surveyed. Response rate was 55% (44/80). Of those surveyed, 57% (25/44) had no written departmental vaccination guidelines. Although 90% of those surveyed agreed that the responsibility for ensuring vaccine compliance rests with health professionals, only 5% considered that the rheumatology clinic was the best setting in which to accomplish this. Half (50%, n = 22) of practicing rheumatologists do not inquire about vaccination history in the clinic, with a minority (9%, n = 4) recording vaccination history in their clinical notes. A significant percentage of rheumatologists do not perform screening about prior vaccination before initiation of either anti-tumor necrosis factor (34%) or disease-modifying antirheumatic disease (42%) therapy. Moreover, 57% (n = 25) considered the responsibility for vaccination the domain of the patients' general practitioners with the favored strategy to improve vaccine compliance being led by the primary care physicians (48%, n = 21).
The practice of Irish rheumatologists with regard to vaccination in this survey was suboptimal. Most neither recommend nor record vaccination history in their clinical notes, with the majority feeling that the rheumatology clinic is not the appropriate setting in which to target strategies to improve vaccine compliance. Although a more proactive role needs to be taken by rheumatologists as the principal prescribers of immunosuppressive therapy on this issue, our survey respondents suggest that strategies to improve vaccine uptake should be developed outside the rheumatology clinic and, in particular, involve primary care. The circulation of currently available international guidelines on vaccination specific for rheumatology patients to primary care physicians should be used to inform practices to ensure improved vaccine compliance.
患有炎症性关节炎的患者感染风险增加。该人群中许多感染负担是可以通过疫苗预防的。一些国际风湿病组织已经发布了成人患者接种疫苗的专家建议。尽管如此，炎症性关节炎患者的报告接种率仍然很低。
我们旨在确定风湿病医生在接种疫苗方面的知识、态度和临床实践。
2009 年在爱尔兰执业的风湿病医生通过邮寄问卷进行调查。收集的数据输入 Microsoft Excel 并使用 SPSS18 软件进行统计分析。
共调查了 80 名（100%）执业风湿病医生。应答率为 55%（44/80）。在接受调查的人群中，57%（25/44）没有书面部门疫苗接种指南。尽管 90%的调查对象认为确保疫苗接种合规的责任在于卫生专业人员，但只有 5%的人认为风湿病诊所是实现这一目标的最佳场所。一半（50%，n=22）的执业风湿病医生在诊所不询问疫苗接种史，少数（9%，n=4）在临床记录中记录疫苗接种史。相当一部分风湿病医生在开始使用抗肿瘤坏死因子（34%）或改善病情抗风湿药物（42%）治疗之前，不会对先前的疫苗接种情况进行筛查。此外，57%（n=25）认为接种疫苗的责任在于患者的全科医生，他们认为改善疫苗接种率的最佳策略是由初级保健医生主导（48%，n=21）。
在这项调查中，爱尔兰风湿病医生在接种疫苗方面的做法并不理想。大多数医生既不建议也不在临床记录中记录疫苗接种史，大多数人认为风湿病诊所不是提高疫苗接种率的适当场所。尽管在这一问题上，作为免疫抑制治疗的主要处方者，风湿病医生需要发挥更积极的作用，但我们的调查对象建议，应在风湿病诊所之外制定提高疫苗接种率的策略，特别是要涉及初级保健。应将目前针对风湿病患者的疫苗接种国际指南分发给初级保健医生，以告知他们的做法，确保提高疫苗接种率。
