提高慢性肾脏病患者流感疫苗接种率的策略。
Strategies for Improving Influenza Vaccination Rates in Patients with Chronic Renal Disease.
机构信息
Department of Nephrology and Hypertension. University Hospital Schleswig-Holstein; Department of Strategic Data Analysis and Health Policy North Rhine-Westphalia, North Rhine Association of Statutory Health Insurance Physicians, Düsseldorf; IKK Südwest, Saarbrücken; Medical Department, Division of Infectiology and Pneumology, Faculty of Medicine, Charite Berlin; Center for Renal, Hypertensive, and Metabolic Diseases, Hanover; Institute of Medical Informatics and Statistics, University of Kie; Division of Information Technology-Analysis and Development, Schleswig-Holstein Association of Statutory Health Insurance Physicians, Bad Segeberg; Thuringia Association of Statutory Health Insurance Physicians, Weimar.
出版信息
Dtsch Arztebl Int. 2019 Jun 10;116(23-24):413-419. doi: 10.3238/arztebl.2019.0413.
BACKGROUND
The influenza vaccination rate among older and chronically ill patients in Germany has declined in the past decade in spite of vaccination campaigns.
METHODS
The influenza vaccination rate among persons with chronic renal disease was studied with the aid of billing data from various Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen, ASHIPs) in Germany. It was tested in a randomized controlled trial whether a written vaccination appeal, sent by physicians to patients, led to an increase in the vaccination rate. It was tested in a further such trial whether the vaccination rate among patients with renal disease could be improved by an appeal for vaccination that was sent by the ASHIPs to the treating nephrologists. Finally, it was also tested in a prospective interventional study whether the vaccination rate could be improved by an appeal for vaccination sent by a health- insurance carrier directly to the patients.
RESULTS
In 2012-2017, the vaccination rate among persons with chronically impaired renal function ranged from 41.1% to 46.9%; it ranged from 31.7% to 33.7% in kidney transplant recipients and from 42.7% to 44.7% in dialysis patients. An appeal for vaccination that was sent from physicians to patients raised the vaccination rate by 8.3% in the intervention group compared to the control group (p = 0.03; number needed to treat [NNT]: 13). On the other hand, an appeal for vaccination that was sent to the nephrologists lowered the vaccination rate by 0.8% in the intervention group compared to the control group. Finally, an appeal for vaccination that was sent by the health-insurance fund to the patients raised the vaccination rate by 3.2% (p<0.001; NNT: 32).
CONCLUSION
Fewer than half of all patients with chronic renal failure in Germany are vaccinated against influenza. The vaccination rate was found to be increased only after an appeal for vaccination that was sent directly to the patients. A letter sent to the treating physicians had no positive effect at all.
背景
尽管开展了疫苗接种活动，但在过去十年中，德国老年和慢性病患者的流感疫苗接种率有所下降。
方法
借助德国各法定医疗保险医师协会（Kassenärztliche Vereinigungen，ASHIPs）的计费数据，研究了慢性肾脏疾病患者的流感疫苗接种率。在一项随机对照试验中测试了医生向患者发送书面疫苗接种呼吁是否会提高疫苗接种率。在另一项此类试验中测试了向治疗肾病医生发送疫苗接种呼吁是否可以提高肾病患者的疫苗接种率。最后，还在一项前瞻性干预研究中测试了向患者直接发送医疗保险机构的疫苗接种呼吁是否可以提高疫苗接种率。
结果
2012 年至 2017 年，慢性肾功能受损者的疫苗接种率在 41.1%至 46.9%之间；肾移植受者的疫苗接种率在 31.7%至 33.7%之间，透析患者的疫苗接种率在 42.7%至 44.7%之间。与对照组相比，向患者发送疫苗接种呼吁将干预组的疫苗接种率提高了 8.3%（p=0.03；需要治疗的人数[NNT]：13）。另一方面，向肾病医生发送的疫苗接种呼吁使干预组的疫苗接种率比对照组低 0.8%。最后，向患者发送的医疗保险基金的疫苗接种呼吁将疫苗接种率提高了 3.2%（p<0.001；NNT：32）。
结论
德国不到一半的慢性肾衰竭患者接种流感疫苗。只有在直接向患者发出疫苗接种呼吁后，才发现接种率有所提高。向治疗医生发送的信函根本没有产生积极影响。
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