Kraus D M, Campbell M M, Marcinak J F
Department of Pharmacy Practice, University of Illinois at Chicago.
Arch Pediatr Adolesc Med. 1994 Sep;148(9):936-42. doi: 10.1001/archpedi.1994.02170090050007.
To characterize universal hepatitis B immunization practices of pediatricians who routinely provide childhood immunizations in Illinois.
Survey of 522 randomly chosen Illinois pediatricians. Student's t test, chi 2 analysis, and multivariate logistic regression were used to identify relationships between physician demographics and outcomes of interest.
Physician agreement with the new Centers for Disease Control and Prevention Immunization Practices Advisory Committee and the American Academy of Pediatrics universal infant hepatitis B immunization guidelines, incorporation of the recommendations, routine hepatitis B immunization of older children (aged 6 months to 11 years), and routine hepatitis B immunization of adolescents.
The survey response rate was 71.5%. Of those pediatricians routinely providing immunizations (N = 323), 72.8% agreed with and 90.1% have incorporated universal hepatitis B immunization; 36.5% and 53.0% routinely immunized older children and adolescents, respectively. Pediatricians practicing in medium-sized practices were half as likely to agree with the recommendations (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.31 to 0.84). Cost and a belief that universal immunization of infants is not medically necessary were the two most commonly listed reasons for not incorporating the new guidelines. Percent reimbursement from public aid was negatively related to the routine immunization of older children (OR, 0.34; 95% CI, 0.12 to 0.95). Both percent reimbursement from self-pay (OR, 5.62; 95% CI, 2.25 to 14.05) and a rural location (OR, 0.16; 95% CI, 0.04 to 0.56) were related to routine hepatitis B immunization of adolescents. Gender and number of years in practice were not associated with physician response.
The majority of Illinois pediatricians who routinely provide pediatric immunizations have incorporated the new universal hepatitis B immunization guidelines into their practices. Continued efforts to address financial barriers and to educate physicians may hasten the time when the transmission of the hepatitis B virus will no longer occur.
描述伊利诺伊州常规提供儿童免疫接种服务的儿科医生的普遍乙肝免疫接种情况。
对522名随机选取的伊利诺伊州儿科医生进行调查。采用学生t检验、卡方分析和多因素逻辑回归来确定医生人口统计学特征与感兴趣的结果之间的关系。
医生对新的疾病控制与预防中心免疫实践咨询委员会及美国儿科学会普遍婴儿乙肝免疫接种指南的认同度、对建议的采纳情况、对大龄儿童（6个月至11岁）的常规乙肝免疫接种情况以及对青少年的常规乙肝免疫接种情况。
调查回复率为71.5%。在那些常规提供免疫接种服务的儿科医生中（N = 323），72.8%表示认同且90.1%已采纳普遍乙肝免疫接种；分别有36.5%和53.0%的医生对大龄儿童和青少年进行常规免疫接种。在中等规模诊所执业的儿科医生认同这些建议的可能性只有一半（比值比[OR]，0.51；95%置信区间[CI]，0.31至0.84）。费用以及认为婴儿普遍免疫接种在医学上没有必要是未采纳新指南最常列出的两个原因。公共援助的报销比例与大龄儿童的常规免疫接种呈负相关（OR，0.34；95% CI，0.12至0.95）。自费报销比例（OR，5.62；95% CI，2.25至14.05）和农村地区（OR，0.16；95% CI，0.04至0.56）均与青少年的常规乙肝免疫接种有关。性别和执业年限与医生的回复无关。
伊利诺伊州大多数常规提供儿童免疫接种服务的儿科医生已将新的普遍乙肝免疫接种指南纳入其执业行为。持续努力解决经济障碍并对医生进行教育可能会加快乙肝病毒不再传播的时间。
