Mayo Clinic, 200 First St SW Rochester, MN 55905, USA.
Taylor University, 236 W Reade Ave Upland, IN 46989, USA.
Vaccine. 2018 Mar 27;36(14):1823-1829. doi: 10.1016/j.vaccine.2018.02.082. Epub 2018 Feb 26.
The aims of this study are to evaluate the impact of a novel immunization curriculum based on the Preferred Cognitive Styles and Decision Making Model (PCSDM) on internal medicine (IM) resident continuity clinic patient panel immunization rates, as well as resident immunization knowledge, attitudes, and practices (KAP).
A cluster-randomized controlled trial was performed among 143 IM residents at Mayo Clinic to evaluate the PCSDM curriculum plus fact-based immunization curriculum (intervention) compared to fact-based immunization curriculum alone (control) on the outcomes of resident continuity clinic patient panel immunization rates for influenza, pneumococcal, tetanus, pertussis, and zoster vaccines. Pre-study and post-study immunization KAP surveys were administered to IM residents.
Ninety-nine residents participated in the study. Eighty-two residents completed pre-study and post-study surveys. Influenza and pertussis immunization rates improved for both intervention and control groups. There was no significant difference in immunization rate improvement between the groups. Influenza immunization rates improved significantly by 33.4% and 32.3% in the intervention and control groups, respectively. The odds of receiving influenza immunization at the end of the study relative to pre-study for the entire study cohort was 4.6 (p < 0.0001). The odds of having received pertussis immunization at the end of the study relative to pre-study for the entire study cohort was 1.2 (p = 0.0002). Both groups had significant improvements in immunization knowledge. The intervention group had significant improvements in multiple domains that assessed confidence in counseling patients on immunizations.
Fact-based immunization education was useful in improving IM resident immunization rates for influenza and pertussis. The PCSDM immunization curriculum did not lead to increases in immunization rates compared with the fact-based curriculum, but it did significantly increase resident confidence in communicating with patients about vaccines.
本研究旨在评估基于首选认知风格和决策模型（PCSDM）的新型免疫接种课程对内科（IM）住院医生连续性诊所患者免疫接种率以及住院医生免疫接种知识、态度和实践（KAP）的影响。
在梅奥诊所的 143 名内科住院医生中进行了一项群组随机对照试验，以评估 PCSDM 课程加基于事实的免疫接种课程（干预组）与单独基于事实的免疫接种课程（对照组）对流感、肺炎球菌、破伤风、百日咳和带状疱疹疫苗的住院医生连续性诊所患者免疫接种率的影响。在研究前和研究后对 IM 住院医生进行免疫接种 KAP 调查。
99 名住院医生参与了研究。82 名住院医生完成了研究前和研究后的调查。干预组和对照组的流感和百日咳疫苗接种率均有所提高。两组之间的免疫接种率改善无显著差异。干预组和对照组的流感疫苗接种率分别显著提高了 33.4%和 32.3%。与研究前相比，整个研究队列在研究结束时接受流感疫苗接种的可能性增加了 4.6 倍（p<0.0001）。与研究前相比，整个研究队列在研究结束时接受百日咳疫苗接种的可能性增加了 1.2 倍（p=0.0002）。两组的免疫知识均有显著提高。干预组在评估对患者进行免疫接种咨询的信心的多个领域均有显著提高。
基于事实的免疫教育有助于提高内科住院医生的流感和百日咳疫苗接种率。与基于事实的课程相比，PCSDM 免疫课程并未导致免疫接种率增加，但它确实显著提高了住院医生与患者就疫苗接种进行沟通的信心。
