Xu Fang, deJong Neal, Kappelman Michael D, Greenlund Kurt J, Carlson Susan A
Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
Inflamm Bowel Dis. 2023 May 2;29(5):726-734. doi: 10.1093/ibd/izac129.
Immunization among patients with inflammatory bowel disease (IBD) is suboptimal. We sought to characterize attitudes of US primary care professionals (PCPs) towards immunization practices for patients with IBD.
Using a web-based opt-in panel of PCPs (DocStyles survey, spring 2021, cross-sectional study), we assessed likelihood of PCPs' recommending influenza, pneumococcal disease, herpes zoster, and human papilloma virus vaccinations for IBD patients by PCP characteristics and availability of clinical tools. Reasons for unlikelihood of recommending vaccines and approaches to improve vaccine recommendation were examined.
Among 1503 PCPs, 64% recommended all vaccines. Herpes zoster vaccine was most likely to be recommended (89.8%) and pneumococcal vaccine was least likely (74.0%). Clinical tools including decision support based on electronic health records (EHRs; 48.9%) and staff tracking of patients' vaccine needs (36.3%) were significantly associated with likelihood of recommending vaccines (P < .001). A greater likelihood of vaccine recommendation was observed for pediatricians vs other medical specialties, group outpatient clinic vs other worksites, and seeing >50 patients/week (P < .05). One-third of PCPs were unlikely to recommend ≥1 vaccine, and the top reason reported was unfamiliarity with vaccine guidelines for patients with IBD (48.0%). A review of guidelines or continued medical education (63.0%) and decision support from EHRs (51.2%) were the most frequently selected approaches identified to improve certainty of vaccine recommendation.
There is room for improvement of vaccination recommendations by PCPs. Promoting continuing education and use of clinical tools may help support PCP immunization practices for patients with IBD.
炎症性肠病（IBD）患者的免疫接种情况并不理想。我们试图了解美国初级保健医生（PCP）对IBD患者免疫接种做法的态度。
我们通过一个基于网络的PCP自愿参与小组（DocStyles调查，2021年春季，横断面研究），根据PCP的特征和临床工具的可用性，评估PCP为IBD患者推荐流感、肺炎球菌疾病、带状疱疹和人乳头瘤病毒疫苗接种的可能性。研究了不推荐疫苗接种的原因以及改善疫苗推荐的方法。
在1503名PCP中，64%的人推荐了所有疫苗。带状疱疹疫苗最有可能被推荐（89.8%），肺炎球菌疫苗最不可能被推荐（74.0%）。包括基于电子健康记录（EHR）的决策支持（48.9%）和工作人员对患者疫苗需求的跟踪（36.3%）在内的临床工具与推荐疫苗的可能性显著相关（P < 0.001）。与其他医学专科相比，儿科医生推荐疫苗的可能性更大；与其他工作场所相比，团体门诊诊所推荐疫苗的可能性更大；每周看诊超过50名患者的PCP推荐疫苗的可能性更大（P < 0.05）。三分之一的PCP不太可能推荐至少一种疫苗，报告的首要原因是不熟悉IBD患者的疫苗指南（48.0%）。查阅指南或继续医学教育（63.0%）以及EHR的决策支持（51.2%）是被确定为提高疫苗推荐确定性的最常选择的方法。
PCP的疫苗接种推荐有改进空间。促进继续教育和临床工具的使用可能有助于支持PCP对IBD患者的免疫接种做法。
