Brombacher Felix, Sanftenberg Linda, Klug Stefanie J, Schelling Jörg, Gensichen Jochen
Institut für Allgemeinmedizin, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Deutschland.
Institut für Allgemeinmedizin, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2021 Apr;161:42-49. doi: 10.1016/j.zefq.2021.01.007. Epub 2021 Feb 24.
The current SARS-CoV-2 pandemic requires high influenza vaccination rates for the chronically ill in order to avoid additional strain on the health care system. Despite clear evidence of the safety and effectiveness of influenza vaccination, vaccination coverage has internationally remained at inadequate levels in recent years. The general practitioner is of central importance for the care of this population. Therefore, the aim of this systematic review was to evaluate various measures in general practice to increase seasonal influenza vaccination rates for the chronically ill, taking into account various international health systems.
A systematic literature search was carried out in MEDLINE, CENTRAL, EMBASE and ERIC as well as manually in trial registers and literature lists. Only randomized controlled studies were taken into account. The methodology was defined in advance in a study protocol and published (PROSPERO CRD42018114163).
A total of 14 studies within the framework of a national health service (United Kingdom), a state (Australia) and social (Switzerland) health insurance system and a private health care system (USA) were included in our review. Analog patient reminders and automated physician reminders as well as changes in professional roles have led to a significant increase in influenza vaccination rates, but only in the private health care system. In the national health service, none of the interventions we analyzed achieved a significant increase in vaccination rates, although the National Health Service in the United Kingdom documented relatively good basic influenza vaccination rates before the studies were carried out, regardless of the intervention. Good results were achieved in the social and state health insurance systems of Switzerland and Australia by training events for practice teams and SMS reminders.
In Germany, training events for medical teams and centrally organized invitation and monitoring systems might improve vaccination rates among the chronically ill. That the federal government pays for the vaccination costs seems to ensure a good basic influenza vaccination coverage for indicated patients in various health systems.
当前的新型冠状病毒肺炎大流行要求慢性病患者有较高的流感疫苗接种率，以避免给医疗系统带来额外负担。尽管有明确证据表明流感疫苗接种具有安全性和有效性，但近年来国际上的疫苗接种覆盖率仍处于不足水平。全科医生对于这一人群的护理至关重要。因此，本系统评价的目的是评估全科医疗中的各种措施，以提高慢性病患者的季节性流感疫苗接种率，同时考虑到各种国际卫生系统。
在MEDLINE、CENTRAL、EMBASE和ERIC数据库中进行了系统的文献检索，并手动检索了试验注册库和文献列表。仅纳入随机对照研究。研究方法在研究方案中预先确定并已发表（PROSPERO CRD42018114163）。
我们的评价纳入了14项研究，这些研究分别来自国家卫生服务体系（英国）、州（澳大利亚）和社会（瑞士）医疗保险体系以及私立医疗保健体系（美国）。类似患者提醒、自动医生提醒以及专业角色的改变导致流感疫苗接种率显著提高，但仅在私立医疗保健体系中。在国家卫生服务体系中，我们分析的干预措施均未使疫苗接种率显著提高，尽管英国国家卫生服务体系在研究开展前记录了相对较高的基础流感疫苗接种率，且与干预措施无关。瑞士和澳大利亚的社会及州医疗保险体系通过为实践团队举办培训活动和短信提醒取得了良好效果。
在德国，为医疗团队举办培训活动以及集中组织邀请和监测系统可能会提高慢性病患者的疫苗接种率。联邦政府支付疫苗接种费用似乎能确保在各种卫生系统中为符合条件的患者提供良好的基础流感疫苗接种覆盖率。
