Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, United States.
Vaccine. 2012 Sep 7;30(41):5978-82. doi: 10.1016/j.vaccine.2012.07.023. Epub 2012 Jul 24.
Immunization of adults with influenza vaccine and pneumococcal polysaccharide vaccine remains lower than recommended levels. Standing order programs (SOPs) in which non-physician medical personnel are permitted to assess an adult patient's immunization status and administer vaccines without an individual physician order are a proven method of increasing adult vaccinations, yet they are used by less than one half of primary care physicians caring for adults.
Following a national survey of primary care physicians about barriers to SOPs for adult immunizations, a SOP toolkit was developed. After review by a panel of experts, the toolkit was pilot tested in three primary care practices in a health care network with the same electronic medical record (EMR) system and low adult vaccination rates. Practice staffs were trained in the use of SOPs and the toolkit at a group meeting. This study was designed to pilot-test and evaluate the toolkit with the express intention of improving it. Three methods were used to evaluate the toolkit: (1) direct observation and interviews of each practice's staff; (2) surveys of each practice's staff; and (3) influenza and pneumococcal polysaccharide vaccine (PPV) vaccination rates.
The staffs at all sites were equally likely to find the presentations and toolkit useful and did not differ in their knowledge of using SOPs for vaccination. They expressed a common set of barriers to implementing SOPs despite using the toolkit, and provided ideas for improving implementation. One site viewed SOPs in general in a more negative light and expressed that SOPs unfairly increased their workload. Vaccination rates in this site did not differ from those of the control site.
The evaluation suggested that the SOP toolkit should be expanded to include additional strategies to improve its applicability and effectiveness.
成人接种流感疫苗和肺炎球菌多糖疫苗的比例仍然低于建议水平。在这种情况下，医师可以授权非医务人员在无需医师单独下医嘱的情况下，评估成人患者的免疫状况并接种疫苗，这是一种已被证实可以增加成人疫苗接种率的方法，但目前只有不到一半的成人保健医生使用这种方法。
在对成人免疫接种的 SOP 实施障碍进行了全国性调查后，为初级保健医生制定了 SOP 工具包。在经过专家组审查后，该工具包在一个医疗网络中的三个初级保健诊所进行了试点测试，这些诊所使用相同的电子病历（EMR）系统，且成人疫苗接种率较低。在一次小组会议上，对实践工作人员进行了 SOP 使用和工具包的培训。本研究旨在试点测试和评估工具包，并明确表示要改进它。使用三种方法评估了工具包：（1）对每个实践的工作人员进行直接观察和访谈；（2）对每个实践的工作人员进行调查；（3）流感和肺炎球菌多糖疫苗（PPV）接种率。
所有站点的工作人员都认为演示文稿和工具包同样有用，并且在使用 SOP 进行疫苗接种方面的知识没有差异。他们表示，尽管使用了工具包，但在实施 SOP 方面存在一些共同的障碍，并提出了改进实施的想法。有一个站点通常对 SOP 持更负面的看法，并表示 SOP 不公平地增加了他们的工作量。该站点的疫苗接种率与对照组的疫苗接种率没有差异。
评估结果表明，应扩大 SOP 工具包，以纳入其他策略，以提高其适用性和有效性。
