Gurvits Grigoriy E, Lan Gloria, Tan Amy, Weissman Arlene
Division of Gastroenterology, Department of Medicine, New York University School of Medicine/Langone Medical Center, New York, New York, USA.
Division of Gastroenterology, Department of Medicine, Beth Israel Medical Center, New York, New York, USA.
Postgrad Med J. 2017 Jun;93(1100):333-337. doi: 10.1136/postgradmedj-2016-134266. Epub 2016 Oct 12.
Increasing prevalence of inflammatory bowel disease (IBD) poses significant challenges to medical community. Preventive medicine, including vaccination against opportunistic infections, is important in decreasing morbidity and mortality in patients with IBD. We conduct first study to evaluate general awareness and adherence to immunisation guidelines by primary care physicians in the USA.
We administered an electronic questionnaire to the research panel of the American College of Physicians (ACP) assessing current vaccination practices, barriers to vaccination and provider responsibility for administering vaccinations and compared responses with the European Crohn's and Colitis Organization consensus guidelines and expert opinion from the USA.
All of surveyed physicians (276) had experience with patients with IBD and spent majority of their time in direct patient care. 49% of physicians took immunisation history frequently or always, and 76% reported never or rarely checking immunisation antibody titres with only 2% doing so routinely. 65% of physicians believed that primary care providers (PCPs) were responsible for determining patient's immunisation. Vaccine administration was felt to be the duty of primary care doctor 80% of the time. 2.5% of physicians correctly recommended vaccinations all the time. Physicians were more likely to recommend vaccination to immunocompetent than immunocompromised patients. Up to 23% of physicians would incorrectly recommend live vaccine to immunocompromised patients with IBD.
Current knowledge and degree of comfort among PCPs in the USA in preventing opportunistic infections in IBD population remain low. Management of patients with IBD requires structured approach to their healthcare maintenance in everyday practice, including enhanced educational policy aimed at primary care physicians.
炎症性肠病（IBD）患病率的不断上升给医学界带来了重大挑战。预防医学，包括针对机会性感染的疫苗接种，对于降低IBD患者的发病率和死亡率至关重要。我们开展了第一项研究，以评估美国初级保健医生对免疫指南的总体认识和遵循情况。
我们向美国医师协会（ACP）的研究小组发放了一份电子问卷，评估当前的疫苗接种实践、疫苗接种的障碍以及疫苗接种提供者的责任，并将回答与欧洲克罗恩病和结肠炎组织的共识指南以及美国的专家意见进行比较。
所有接受调查的医生（276名）都有治疗IBD患者的经验，并且大部分时间都用于直接的患者护理。49%的医生经常或总是询问免疫接种史，76%的医生报告从未或很少检查免疫抗体滴度，只有2%的医生会定期这样做。65% 的医生认为初级保健提供者（PCP）负责确定患者的免疫接种情况。80%的情况下，疫苗接种被认为是初级保健医生的职责。2.5%的医生始终正确推荐疫苗接种。与免疫功能低下的患者相比，医生更有可能向免疫功能正常的患者推荐疫苗接种。高达23%的医生会错误地向患有IBD的免疫功能低下患者推荐活疫苗。
美国初级保健医生在预防IBD人群机会性感染方面的现有知识和舒适度仍然较低。IBD患者的管理需要在日常实践中采用结构化的方法来进行医疗保健维护,包括针对初级保健医生加强教育政策。
