Department of Obstetrics and Gynecology, Wake Forest, Winston-Salem, North Carolina, USA.
Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA.
Int J Gynaecol Obstet. 2023 Jul;162(1):169-175. doi: 10.1002/ijgo.14775. Epub 2023 Apr 20.
The authors investigated tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccination during pregnancy following Advisory Committee on Immunization Practices' (ACIP's) recommendation for antenatal pertussis vaccination.
A retrospective chart review was performed in 2019 of women receiving prenatal care at our institution between January 1, 2014 and December 31, 2018. Receipt of ACIP-recommended vaccines were examined using Current Procedural Terminology codes to identify initiation of prenatal care, then administration of Tdap and influenza vaccines. Data were examined by individual practice (university faculty, community physicians, obstetrics and gynecology (OBGYN) residents, and family medicine residents, practice staff composition, vaccination protocol use, and insurance status. Statistical analyses were performed using χ testing and χ testing of linear trend.
Within our cohort (n = 17 973), highest vaccination uptake occurred in the university-based OBGYN faculty practice (Tdap = 58.2%, influenza = 56.5%) with lowest uptake in the OBGYN resident practice (Tdap = 28.6%, influenza = 18.5%). Higher uptake occurred in practices with standing orders, more advanced practice providers, lower provider to nursing ratios, and lower rates of Medicaid insurance.
These data demonstrated higher vaccination uptake with standing orders, more advanced practice providers, and lower provider to nurse ratios. Future work optimizing practice staff composition and vaccination protocols may increase vaccine uptake.
作者研究了破伤风类毒素、白喉类毒素和无细胞百日咳（Tdap）以及流感疫苗在产前接种疫苗后，根据免疫实践咨询委员会（ACIP）的建议进行接种的情况。
在 2019 年，对 2014 年 1 月 1 日至 2018 年 12 月 31 日期间在本机构接受产前护理的妇女进行了回顾性图表审查。使用当前程序术语代码检查 ACIP 推荐疫苗的接种情况，以确定产前护理的开始时间，然后是 Tdap 和流感疫苗的接种情况。通过个体实践（大学教师、社区医生、妇产科住院医师和家庭医学住院医师、实践人员构成、疫苗接种方案使用情况和保险状况）来检查数据。使用卡方检验和线性趋势卡方检验进行统计分析。
在我们的队列中（n=17973），大学妇产科教师实践中的疫苗接种率最高（Tdap=58.2%，流感=56.5%），妇产科住院医师实践中的接种率最低（Tdap=28.6%，流感=18.5%）。在有固定医嘱、更多高级执业医师、更低的医生与护士比例以及 Medicaid 保险率较低的实践中，接种率更高。
这些数据表明，有固定医嘱、更多高级执业医师和更低的医生与护士比例的情况下，疫苗接种率更高。未来优化实践人员构成和疫苗接种方案的工作可能会提高疫苗接种率。
