Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA; Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA.
Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA.
Vaccine. 2020 Jun 19;38(30):4740-4746. doi: 10.1016/j.vaccine.2020.05.015. Epub 2020 May 15.
To explore pediatric clinicians' attitudes, beliefs, and perceived social norms about the impact of delayed vaccine schedules on the clinical management of their patients.
We conducted 30 semi-structured qualitative interviews with academic (Infectious Diseases, Emergency Medicine) and community pediatric clinicians (General Pediatrics) to explore clinicians' perspectives on how delayed schedules influence their clinical management of patients. The interview guide was based on the Theory of Planned Behavior. We analyzed interview transcripts using both an inductive and deductive thematic approach.
The pediatric clinicians in our study overwhelmingly supported the recommended schedule, sought guidance on approaches to navigating conversations with vaccine hesitant families, and desired more evidence to effectively promote on-time vaccination. Clinicians described how delayed schedules have consequences for sick children (e.g., increased antibiotics, laboratory tests, emergency department visits) and healthy children (e.g., increased vaccine visits, out-of-pocket costs, fears among children receiving frequent shots). Clinicians stated that delayed schedules also negatively impact pediatric practices (e.g., increased time counseling patients, staff burden, clogged clinic space, unpredictable vaccine utilization, costs).
Pediatric clinicians perceive that delayed vaccine schedules negatively affect patients, pediatric practices, the healthcare system, and society. Future research should quantify the consequences of delayed schedules and identify strategies that promote vaccine adherence. Results from future studies can better support clinician-parent conversations about vaccine hesitancy, guide decision-makers about practice-level approaches to vaccine schedules, and advise payors and policymakers regarding vaccine-related policies.
探讨儿科临床医生对延迟疫苗接种计划对患者临床管理影响的态度、信念和感知的社会规范。
我们对学术（传染病学、急诊医学）和社区儿科临床医生（普通儿科学）进行了 30 次半结构化定性访谈，以探讨临床医生对延迟计划如何影响其对患者的临床管理的看法。访谈指南基于计划行为理论。我们使用归纳和演绎主题分析方法对访谈记录进行了分析。
我们研究中的儿科临床医生绝大多数都支持推荐的时间表，寻求有关如何与疫苗犹豫不决的家庭进行对话的指导，并希望有更多的证据来有效促进按时接种疫苗。临床医生描述了延迟计划对患病儿童（例如，抗生素、实验室检查、急诊就诊次数增加）和健康儿童（例如，疫苗接种次数增加、自付费用增加、经常接受注射的儿童的恐惧）的后果。临床医生表示，延迟计划也会对儿科实践产生负面影响（例如，为患者咨询的时间增加、员工负担增加、诊所空间拥挤、疫苗利用率不可预测、成本增加）。
儿科临床医生认为，延迟疫苗接种计划会对患者、儿科实践、医疗保健系统和社会产生负面影响。未来的研究应该量化延迟计划的后果，并确定促进疫苗接种的策略。未来研究的结果可以更好地支持临床医生与家长就疫苗犹豫进行沟通，为决策者提供有关疫苗接种计划的实践方法提供指导，并为支付者和政策制定者提供有关疫苗相关政策的建议。
