Freed G L, Bordley W C, Clark S J, Konrad T R
Division of Community Pediatrics, University of North Carolina, Chapel Hill 27599-7590.
Pediatrics. 1994 May;93(5):747-51.
In November 1991 the Advisory Committee on Immunization Practice (ACIP) recommended universal hepatitis B immunization of infants. In February 1992 the American Academy of Pediatrics (AAP) and in August 1992 the American Academy of Family Physicians (AAFP) issued similar recommendations. The purpose of this study was to assess over time the effectiveness and impact of the dissemination efforts of the ACIP, AAP, and AAFP regarding this new recommendation and to determine the factors affecting its adoption.
Cohort survey over time.
North Carolina.
All 778 pediatricians and a random sample of 300 family physicians in North Carolina were surveyed by mail 3 months after publication of the ACIP recommendation (January/February 1992), but before the AAP and AAFP recommendations. Response rate was 78%. Of these, 83% responded to a follow-up survey 8 months later (October 1992).
Rates of agreement and adoption of the recommendation for universal infant immunization with hepatitis B vaccine; factors affecting agreement and adoption of the recommendation.
In the first survey (3 months after the ACIP recommendation) more pediatricians than family physicians were aware of the new recommendation (82% vs 48%), yet only 37% of pediatricians and 23% of family physicians agreed that immunization of all newborns in their practice was warranted. Eight months later, after the AAP and AAFP recommendation, 66% of pediatricians and 32% of family physicians agreed universal immunization was warranted, but still only 53% of pediatricians and 23% of family physicians had adopted it into practice. Factors associated with these low rates of adoption include physician and practice characteristics, cost, perceived need for the vaccine, and aversion to multiple injections.
Federal, AAP, and AAFP efforts have not been effective thus far in fostering widespread agreement and adoption of this recommendation. If this and future vaccine programs are to succeed, research is needed to determine influences on implementation of new recommendations and to address the economic and noneconomic concerns of physicians and parents.
1991年11月，免疫实践咨询委员会（ACIP）建议对婴儿进行普遍的乙肝疫苗接种。1992年2月，美国儿科学会（AAP）以及1992年8月美国家庭医师学会（AAFP）发布了类似建议。本研究的目的是长期评估ACIP、AAP和AAFP关于这一新建议的传播努力的有效性和影响，并确定影响该建议采用的因素。
长期队列调查。
北卡罗来纳州。
在ACIP建议发布后3个月（1992年1月/2月），但在AAP和AAFP建议发布之前，通过邮件对北卡罗来纳州的所有778名儿科医生和300名家庭医生的随机样本进行了调查。回复率为78%。其中，83%的人在8个月后（1992年10月）回复了后续调查。
对普遍为婴儿接种乙肝疫苗建议的认同率和采用率；影响对该建议认同和采用的因素。
在第一次调查（ACIP建议发布后3个月）中，了解这一新建议的儿科医生比家庭医生更多（82%对48%），然而，只有37%的儿科医生和23%的家庭医生认为在他们的执业中对所有新生儿进行免疫接种是必要的。8个月后，在AAP和AAFP发布建议后，66%的儿科医生和32%的家庭医生认为普遍免疫接种是必要的，但仍只有53%的儿科医生和23%的家庭医生将其纳入实践。与这些低采用率相关的因素包括医生和执业特征、成本、对疫苗的感知需求以及对多次注射的反感。
到目前为止，联邦政府、AAP和AAFP的努力在促进对这一建议的广泛认同和采用方面并不有效。如果这一疫苗计划及未来的疫苗计划要取得成功，需要开展研究以确定对新建议实施的影响，并解决医生和家长的经济和非经济担忧。
