Szilagyi P G, Roghmann K J, Campbell J R, Humiston S G, Winter N L, Raubertas R F, Rodewald L E
Department of Pediatrics, University of Rochester, School of Medicine and Dentistry, NY.
Arch Pediatr Adolesc Med. 1994 Feb;148(2):158-66. doi: 10.1001/archpedi.1994.02170020044007.
To assess variations in immunization practices and attitudes among primary care providers and to relate these characteristics to the immunization levels of their patients.
Monroe County, New York.
Survey of pediatricians (n = 96) and family practitioners (n = 44) to assess immunization practices and attitudes and medical chart reviews for 1884 patients of 32 physicians who practice in the city of Rochester to measure immunization levels.
Tabular analyses for survey responses (chi 2 test and Fisher's Exact Test); logistic regression to assess the relation between provider responses and measured immunization levels.
Responses by pediatricians and family practitioners were similar. Most providers did not routinely immunize during acute-illness visits but did immunize during follow-up or chronic-illness visits. Few used tracking systems to identify underimmunized children. Most practitioners immunized children who had colds but withheld immunizations from children who had fevers or otitis media. Most providers agreed with expanding immunization programs to include sick visits, health department clinic visits, and community site visits, but most thought that they should not be provided at emergency department visits, except for very-high-risk children. Immunization levels at 10 months of age were positively correlated with private practice setting (P = .001) but negatively correlated with immunizing at acute- (P < .01) or chronic-illness (P < .05) visits, Medicaid coverage (P < .05), and high rates of appointments that were not kept (P < .001).
Primary care providers' immunization practices and attitudes vary and do not always follow established guidelines for immunization delivery. Many providers of high-risk children are already attempting to improve immunization delivery by using patient reminders and by immunizing children at acute- or chronic-illness visits. Improving provider immunization practices to deliver childhood immunizations more effectively must be part of our efforts to resolve this nation's childhood immunization problem.
评估初级保健提供者免疫接种行为及态度的差异，并将这些特征与他们患者的免疫接种水平相关联。
纽约州门罗县。
对儿科医生（n = 96）和家庭医生（n = 44）进行调查，以评估免疫接种行为及态度，并对在罗切斯特市执业的32名医生的1884名患者的病历进行审查，以测量免疫接种水平。
对调查回复进行表格分析（卡方检验和费舍尔精确检验）；采用逻辑回归评估提供者回复与所测免疫接种水平之间的关系。
儿科医生和家庭医生的回复相似。大多数提供者在急性病就诊期间不常规进行免疫接种，但在随访或慢性病就诊期间进行免疫接种。很少有人使用追踪系统来识别未充分免疫的儿童。大多数从业者会为感冒儿童进行免疫接种，但不给发烧或患中耳炎的儿童接种。大多数提供者同意扩大免疫接种计划，将患病就诊、卫生部门诊所就诊和社区场所就诊纳入其中，但大多数人认为，除极高风险儿童外，急诊就诊时不应进行免疫接种。10个月大时的免疫接种水平与私人执业环境呈正相关（P = .001），但与在急性病（P < .01）或慢性病（P < .05）就诊时进行免疫接种、医疗补助覆盖（P < .05）以及高失约率（P < .001）呈负相关。
初级保健提供者的免疫接种行为及态度各不相同，并不总是遵循既定的免疫接种实施指南。许多高危儿童的提供者已经在尝试通过使用患者提醒以及在急性病或慢性病就诊时为儿童进行免疫接种来改善免疫接种实施情况。改善提供者的免疫接种行为以更有效地提供儿童免疫接种，必须成为我们解决该国儿童免疫接种问题努力的一部分。
