Szilagyi P G, Rodewald L E, Humiston S G, Hager J, Roghmann K J, Doane C, Cove L, Fleming G V, Hall C B
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY.
Pediatrics. 1994 Oct;94(4 Pt 1):517-23.
To assess current practices and attitudes among pediatricians and family physicians across the United States regarding immunizations.
Survey of a random sample of pediatricians and family physicians.
Fellows of the American Academy of Pediatrics (N = 746) and American Academy of Family Medicine (N = 429). SURVEY TOPICS: General immunization practices (eg, types of visits during which vaccinations are provided, mechanisms to identify undervaccinated children); and opinions about perceived barriers to immunizations, acceptance of alternative sites for immunizations, and possible immunization requirements for Medicaid and The Special Supplemental Food Program for Women, Infants, and Children (WIC).
Pediatricians and family physicians (combined) reported the following: immunizing children during acute illness visits (28%), follow-up visits (90%), and chronic illness visits (77%); using computer or reminder files to identify undervaccinated children (13%); and simultaneously administering four vaccines (diphtheria-tetanus-pertussis, oral poliovaccine, measles, mumps, and rubella and Haemophilus influenzae type b) to an eligible 18-month-old child (66%). Physicians perceived the following as barriers to immunizations: missed preventive visits (40%), vaccine costs (24%), lack of insurance coverage (24%), inability to track undervaccinated patients (22%), incomplete immunization records (12%), and missed vaccination opportunities (12%). Physicians agreed with offering vaccinations during hospitalizations (51%) or emergency department visits (30%), and with immunization requirements for continued eligibility for Medicaid (66%) or WIC (64%). Pediatricians were more likely to vaccinate during chronic illness and follow-up visits, and were more likely to use systems to track undervaccinated children (P < .05); however, most immunization practices and attitudes of pediatricians and family physicians were similar. Physicians who graduated from medical school more recently and those in high-risk urban practices were more likely to vaccinate during acute illness visits, provide simultaneous vaccinations, and favor vaccinations in hospital settings.
Vaccination rates might be improved by closer adherence to current immunization guidelines regarding vaccinations during all encounters and simultaneous vaccinations, by developing systems to identify undervaccinated children, and by reducing patient costs for vaccinations. Current immunization practices fall short of the immunization guidelines; changes in individual practice styles will be required to conform with these standards.
评估美国儿科医生和家庭医生在免疫接种方面的当前做法和态度。
对儿科医生和家庭医生的随机样本进行调查。
美国儿科学会会员（N = 746）和美国家庭医学学会会员（N = 429）。
一般免疫接种做法（例如，提供疫苗接种的就诊类型、识别未充分接种疫苗儿童的机制）；以及对免疫接种的感知障碍、对替代免疫接种部位的接受度以及医疗补助计划和妇女、婴儿及儿童特别补充食品计划（WIC）可能的免疫接种要求的看法。
儿科医生和家庭医生（综合）报告了以下情况：在急性病就诊时为儿童接种疫苗（28%）、随访就诊时（90%）以及慢性病就诊时（77%）；使用计算机或提醒文件来识别未充分接种疫苗的儿童（13%）；以及为符合条件的18个月大儿童同时接种四种疫苗（白喉-破伤风-百日咳、口服脊髓灰质炎疫苗、麻疹、腮腺炎和风疹以及b型流感嗜血杆菌疫苗）（66%）。医生们认为以下是免疫接种的障碍：错过预防性就诊（40%）、疫苗费用（24%）、缺乏保险覆盖（24%）、无法追踪未充分接种疫苗的患者（22%）、免疫接种记录不完整（12%）以及错过疫苗接种机会（12%）。医生们同意在住院期间（51%）或急诊科就诊时（30%）提供疫苗接种，并同意对医疗补助计划（66%）或WIC（64%）继续符合资格的免疫接种要求。儿科医生在慢性病和随访就诊时更有可能接种疫苗，并且更有可能使用系统来追踪未充分接种疫苗的儿童（P < 0.05）；然而，儿科医生和家庭医生的大多数免疫接种做法和态度是相似的。最近从医学院毕业的医生以及在高风险城市执业的医生在急性病就诊时更有可能接种疫苗、同时接种疫苗，并赞成在医院环境中接种疫苗。
通过更严格地遵守当前关于在所有就诊时进行疫苗接种和同时接种疫苗的免疫接种指南、开发识别未充分接种疫苗儿童的系统以及降低疫苗接种的患者费用，可能提高疫苗接种率。当前的免疫接种做法未达到免疫接种指南的要求；需要改变个人的执业方式以符合这些标准。
