Srivanichakom Weerachai, Asavathitanonta Kamchana, Washirasaksiri Chaiwat, Chaisathaphon Thanet, Chouriyagune Charoen, Phisalprapa Pochamana, Pandejpong Denla
J Med Assoc Thai. 2014 Dec;97(12):1281-9.
Annual epidemics of influenza viruses remain a substantial cause of morbidity and mortality worldwide particularly among vulnerable groups. Immunization is another way to reduce the infection and mortality rates, especially in high-risk groups; however the data concerning prescription rates and possible influencing factors on decisions associated with influenza prescription of Thai internal medicine residents were limited
Siriraj internal medicine residency training has provided outpatient continuum care practice for all 1st year residents since 2008. A part of the curriculum was to prepare each trainee to be an effective vaccinator. This study aims to examine the competency ofthose residents who had completed the training, particularly about prescribing influenza vaccine.
The authors retrospectively reviewed medical records of the patients that indicated need for influenza vaccine encountered by 2nd and 3rd year residents during June 2011 and May 2012. The 20-item questionnaire was also sent out in order to study possible factors associated on prescribing the vaccine.
Three hundred and seventy-three medical records were included and reviewed. The prescription rate of influenza vaccine was 8.0 percent. Comparing vaccine receiving and non-receiving groups, the authors found having respiratory problems (26.7% vs. 4.4%; odds ratio 8.0 [3.0-20.8]; p < 0.001) and being self-paying (16.7% vs. 5.8%; odds ratio 3.2 [1.1-9.3]; p = 0.023) were the only two significant differences. Only 5.7 percent of total residents were an effective vaccinator One hundred and five residents returned the questionnaire. Residents who had further plans for fellowship trainings had reported a higher influenza vaccine prescription rate than those who will be general internists (45.2% vs. 8.1%; adjusted odds ratio 14.04 [1.6-125.8]; p = 0.018). The authors also found that the rate of vaccine recognition, general knowledge of vaccination, and vaccine coverage remained 61.9%, 29.5%, and 21.0% among medicine residents.
Prescribing rate of influenza vaccine remained low due to multifactor aspects, including doctor capability, attitude, patient recognition as well as reimbursement issues. In order to improve the rate of influenza vaccine prescriptions, a system-designed approach would be needed.
流感病毒的年度流行仍是全球发病和死亡的一个重要原因，尤其是在弱势群体中。免疫接种是降低感染率和死亡率的另一种方式，特别是在高危人群中；然而，关于泰国内科住院医师流感疫苗处方率及与流感疫苗处方相关决策的可能影响因素的数据有限。
自2008年以来，诗里拉吉医院内科住院医师培训为所有一年级住院医师提供了门诊连续护理实践。课程的一部分是让每位学员成为一名有效的疫苗接种者。本研究旨在考察完成培训的住院医师的能力，特别是在开具流感疫苗处方方面的能力。
作者回顾性审查了2011年6月至2012年5月期间二年级和三年级住院医师遇到的有流感疫苗接种需求的患者的病历。还发放了一份包含20个条目的问卷，以研究与开具疫苗处方相关的可能因素。
共纳入并审查了373份病历。流感疫苗的处方率为8.0%。比较接种疫苗组和未接种疫苗组，作者发现有呼吸道问题（26.7%对4.4%；优势比8.0[3.0 - 20.8]；p < 0.001）和自费（16.7%对5.8%；优势比3.2[1.1 - 9.3]；p = 0.023）是仅有的两个显著差异。在所有住院医师中，只有5.7%是有效的疫苗接种者。105名住院医师回复了问卷。有继续参加专科培训计划的住院医师报告的流感疫苗处方率高于那些将成为普通内科医生的住院医师（45.2%对8.1%；调整后优势比14.04[1.6 - 125.8]；p = 0.018）。作者还发现，内科住院医师中疫苗认知率、疫苗接种常识和疫苗接种覆盖率分别为61.9%、29.5%和21.0%。
由于多方面因素，包括医生能力、态度、患者认知以及报销问题，流感疫苗的处方率仍然较低。为了提高流感疫苗的处方率，需要一种系统设计的方法。
