Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 13123 East 16th Ave, Box 055, Aurora, CO, 80045, USA.
Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Gen Intern Med. 2019 Oct;34(10):2167-2175. doi: 10.1007/s11606-019-05164-7. Epub 2019 Jul 19.
Seasonal influenza vaccination is recommended for all adults; however, little is known about how primary care physicians can communicate effectively with patients about influenza vaccination.
To assess among general internal medicine (GIM) and family physicians (FP) regarding adult influenza vaccination: (1) recommendation and administration practices, (2) barriers to discussing and perceived reasons for patient refusal, and (3) factors associated with physician self-efficacy in convincing patients to be vaccinated.
Email and mail survey conducted in February-March 2017 PARTICIPANTS: Nationally representative sample of GIM and FP MAIN MEASURES: Factor analysis was used to group similar items for multivariable analysis of barriers and strategies associated with high physician self-efficacy about convincing patients to be vaccinated (defined as disagreeing that they could do nothing to change resistant patients' minds).
Response rate was 67% (620/930). Ninety-eight percent always/almost always recommended influenza vaccine to adults ≥ 65 years, 90% for adults 50-64 years, and 75% for adults 19-49 years. Standing orders (76%) and electronic alerts (64%) were the most commonly used practice-based immunization strategies. Frequently reported barriers to discussing vaccination were other health issues taking precedence (41%), time (29%), and feeling they were unlikely to change patients' minds (24%). Fifty-eight percent of physicians reported high self-efficacy about convincing patients to be vaccinated; these providers reported fewer patient belief barriers contributing to vaccine refusal (RR = 0.93 per item; 95% CI (0.89-0.98); Cronbach's α = 0.70), were more likely to report using both fact- (1.08/item; (1.03-1.14); 0.66) and personal experience-based (1.07/item; (1.003-1.15); 0.65) communication strategies, and were more likely to work in practices using patient reminders for influenza vaccine (1.32; (1.16-1.50)).
Physicians identified barriers to successfully communicating about adult influenza vaccination but few effective strategies to counter them. Interventions to promote self-efficacy in communication and under-utilized practice-based immunization strategies are needed.
季节性流感疫苗推荐所有成年人接种；然而，对于初级保健医生如何与患者就流感疫苗接种进行有效沟通，我们知之甚少。
评估普通内科医生（GIM）和家庭医生（FP）在成人流感疫苗接种方面的情况：（1）推荐和管理实践，（2）讨论障碍和患者拒绝的感知原因，以及（3）与医生说服患者接种疫苗的自我效能相关的因素。
2017 年 2 月至 3 月进行的电子邮件和邮件调查。
GIM 和 FP 的全国代表性样本。
采用因子分析对与高医生自我效能相关的说服患者接种疫苗的障碍和策略进行多变量分析（定义为不同意他们无法改变抗拒患者的想法）。
回应率为 67%（620/930）。98%的医生始终/几乎始终向≥65 岁的成年人推荐流感疫苗，90%的医生向 50-64 岁的成年人推荐，75%的医生向 19-49 岁的成年人推荐。常规医嘱（76%）和电子提醒（64%）是最常用的基于实践的免疫策略。经常报告的讨论疫苗接种的障碍是其他健康问题优先（41%），时间（29%），并认为他们不太可能改变患者的想法（24%）。58%的医生报告说，他们对说服患者接种疫苗具有高度的自我效能；这些医生报告说，导致疫苗接种拒绝的患者信念障碍较少（RR=每项目 0.93；95%CI（0.89-0.98）；Cronbach's α=0.70），更有可能报告同时使用事实（每项目 1.08；（1.03-1.14）；0.66）和个人经验为基础的沟通策略（每项目 1.07；（1.003-1.15）；0.65），并且更有可能在使用流感疫苗患者提醒的实践中工作（1.32；（1.16-1.50））。
医生确定了成功沟通成人流感疫苗接种的障碍，但很少有有效的策略来应对这些障碍。需要干预措施来提高沟通方面的自我效能，并利用未充分利用的基于实践的免疫策略。
