Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado;
Departments of Pediatrics and.
Pediatrics. 2020 May;145(5). doi: 10.1542/peds.2019-1855.
Standing orders are an effective way to increase vaccination rates, yet little is known about how pediatricians use this strategy for childhood immunizations. We assessed current use of, barriers to using, and factors associated with use of standing orders for vaccination among pediatricians.
Internet and mail survey from June 2017 to September 2017 among a nationally representative sample of pediatricians. In the principal component analysis of barrier items, we identified 2 factors: physician responsibility and concerns about office processes. A multivariable analysis that included barrier scales and physician and/or practice characteristics was used to identify factors associated with use of standing orders.
The response rate was 79% (372 of 471); 59% of respondents reported using standing orders. The most commonly identified barriers among nonusers were concern that patients may mistakenly receive the wrong vaccine (68%), concern that patients prefer to speak with the physician about a vaccine before receiving it (62%), and belief that it is important for the physician to be the person who recommends a vaccine to patients (57%). These 3 items also made up the physician responsibility barrier factor. Respondents with higher physician responsibility scores were less likely to use standing orders (risk ratio: 0.59 [95% confidence interval: 0.53-0.66] per point increase). System-level decision-making about vaccines, suburban or rural location, and lower concerns about office processes scores were each associated with use of standing orders in the bivariate, but not the multivariable, analysis.
Among pediatricians, use of standing orders for vaccination is far from universal. Interventions to increase use of standing orders should address physicians' attitudinal barriers as well as organizational factors.
医嘱是提高疫苗接种率的有效方法，但对于儿科医生如何使用这一策略来进行儿童免疫接种知之甚少。我们评估了儿科医生在接种疫苗方面使用医嘱的现状、使用障碍以及相关因素。
2017 年 6 月至 9 月，采用互联网和邮件对全国代表性的儿科医生样本进行调查。在对障碍项目进行主成分分析时，我们确定了 2 个因素：医生的责任和对办公流程的担忧。采用包括障碍量表和医生及/或实践特征的多变量分析来确定与使用医嘱相关的因素。
应答率为 79%（471 名中的 372 名）；59%的受访者报告使用了医嘱。非使用者中最常见的障碍包括担心患者可能会错误地接种错误的疫苗（68%）、担心患者在接种疫苗之前更愿意与医生讨论疫苗（62%）以及认为医生向患者推荐疫苗非常重要（57%）。这 3 个项目也构成了医生责任障碍因素。医生责任评分较高的受访者不太可能使用医嘱（风险比：每增加 1 分，0.59[95%置信区间：0.53-0.66]）。在单变量分析中，与使用医嘱相关的还有疫苗决策的系统层面、郊区或农村的地理位置和较低的办公流程担忧评分，但在多变量分析中则不然。
在儿科医生中，医嘱在疫苗接种中的使用远非普遍。为了增加医嘱的使用，干预措施应解决医生的态度障碍以及组织因素。
