Leidos Inc., 2295 Parklake Drive NE #300, Atlanta, GA 30345-2844, USA; Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA.
Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA.
Vaccine. 2018 Oct 29;36(45):6772-6781. doi: 10.1016/j.vaccine.2018.09.024. Epub 2018 Sep 20.
The Standards for Adult Immunization Practice (Standards), revised in 2014, emphasize that adult-care providers assess vaccination status of adult patients at every visit, recommend vaccination, administer needed vaccines or refer to a vaccinating provider, and document vaccinations administered in state/local immunization information systems (IIS). Providers report numerous systems- and provider-level barriers to vaccinating adults, such as billing, payment issues, lower prioritization of vaccines due to competing demands, and lack of information about the use and utility of IIS. Barriers to vaccination result in missed opportunities to vaccinate adults and contribute to low vaccination coverage. Clinicians' (physicians, physician assistants, nurse practitioners) and pharmacists' reported barriers to assessment, recommendation, administration, referral, and documentation, provider vaccination practices, and perceptions regarding their adult patients' attitudes toward vaccines were evaluated.
Data from non-probability-based Internet panel surveys of U.S. clinicians (n = 1714) and pharmacists (n = 261) conducted in February-March 2017 were analyzed using SUDAAN. Weighted proportion of reported barriers to assessment, recommendation, administration, referral, and documentation in IIS were calculated.
High percentages (70.0%-97.4%) of clinicians and pharmacists reported they routinely assessed, recommended, administered, and/or referred adults for vaccination. Among those who administered vaccines, 31.6% clinicians' and 38.4% pharmacists' submitted records to IIS. Reported barriers included: (a) assessment barriers: vaccination of adults is not within their scope of practice, inadequate reimbursement for vaccinations; (b) administration barriers: lack of staff to manage/administer vaccines, absence of necessary vaccine storage and handling equipment and provisions; and (c) documentation barriers: unaware if state/city has IIS that includes adults or not sure how their electronic system would link to IIS.
Although many clinicians and pharmacists reported implementing most of the individual components of the Standards, with the exception of IIS use, there are discrepancies in providers' reported actual practices and their beliefs/perceptions, and barriers to vaccinating adults remain.
成人免疫实践标准（Standards）于 2014 年修订，强调成人保健提供者应在每次就诊时评估成年患者的疫苗接种状况，建议接种疫苗，接种所需疫苗或转介给接种提供者，并在州/地方免疫信息系统（IIS）中记录接种疫苗。提供者报告了许多系统和提供者层面的障碍，例如计费、付款问题、由于竞争需求而对疫苗的优先级较低，以及缺乏关于 IIS 使用和效用的信息。接种疫苗的障碍导致错过为成年人接种疫苗的机会，并导致疫苗接种率低。评估了临床医生（医生、医师助理、执业护士）和药剂师报告的评估、建议、管理、转诊和记录障碍、提供者的疫苗接种实践以及他们对成年患者对疫苗的态度的看法。
对美国临床医生（n=1714）和药剂师（n=261）进行的基于非概率性互联网小组调查的数据进行了分析，该调查于 2017 年 2 月至 3 月进行，使用 SUDAAN 进行了分析。计算了在 IIS 中报告的评估、建议、管理、转诊和记录障碍的加权比例。
70.0%-97.4%的临床医生和药剂师报告说，他们经常对成年人进行评估、建议、管理和/或转介接种疫苗。在接种疫苗的人群中，31.6%的临床医生和 38.4%的药剂师将记录提交给 IIS。报告的障碍包括：（a）评估障碍：为成年人接种疫苗不在其执业范围内，接种疫苗的报酬不足；（b）管理障碍：缺乏管理/接种疫苗的人员，缺乏必要的疫苗储存和处理设备和规定；（c）记录障碍：不知道所在州/市是否有包含成年人的 IIS，或者不确定他们的电子系统如何与 IIS 链接。
尽管许多临床医生和药剂师报告实施了标准的大多数单个组件，除了 IIS 的使用之外，提供者报告的实际做法与其信念/看法之间存在差异，并且为成年人接种疫苗的障碍仍然存在。
