Freed G L, Bordley W C, Clark S J, Konrad T R
Division of Community Pediatrics, University of North Carolina, Chapel Hill 27599-7490.
J Fam Pract. 1993 Feb;36(2):153-7.
The incidence of hepatitis B infection has risen 37% over the last decade; 300,000 new infections and 5000 deaths occur annually in the United States. Because immunization programs that targeted high-risk groups failed to abate this increase, the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation to family physicians, (2) the effect of the new recommendation on clinical practice, and (3) the degree to which noneconomic barriers may affect adoption of universal hepatitis B immunization.
A random sample of 300 family physicians in North Carolina was surveyed by mail. Descriptive statistics and chi-square analysis were used to assess the relationship of variables hypothesized to predict physician awareness of, and agreement with, the new recommendation.
The response rate was 78%. Overall, 48% of family physicians who administered immunizations to children were aware of the new hepatitis B vaccine recommendation. However, only 17% agreed that it was warranted for all newborns in their practice. Twenty-five percent expected more than one half of the parents to refuse three injections at a single well-child visit, a result of adding this vaccine to the current primary immunization schedule. Additionally, 42% expected nurses to resist giving three injections at one visit.
The CDC does not have an effective mechanism for disseminating information to all physicians who care for children. Improved coordination of recommendations between the CDC and relevant specialty societies may help to increase physician adoption of new immunization recommendations in their clinical practice. Additionally, practical concerns of physicians and their patients regarding multiple injections and other practice-relevant issues must be considered when formulating new immunization recommendations, if their implementation is to be successful. Additional research is needed to determine effective methods to disseminate immunization information and to address practical concerns of clinicians.
在过去十年中，乙肝感染率上升了37%；在美国，每年有30万新感染病例和5000人死亡。由于针对高危人群的免疫计划未能遏制这种增长，疾病控制中心（CDC）于1991年11月建议对婴儿进行普遍的乙肝免疫接种。详细内容发表在《发病率与死亡率周报》的一份增刊上。本研究的目的是评估：（1）疾病控制中心向家庭医生传播新免疫建议的有效性；（2）新建议对临床实践的影响；（3）非经济障碍可能影响普遍乙肝免疫接种采用的程度。
通过邮件对北卡罗来纳州300名家庭医生进行随机抽样调查。使用描述性统计和卡方分析来评估假设变量之间的关系，这些变量用于预测医生对新建议的知晓程度和认同程度。
回复率为78%。总体而言，为儿童进行免疫接种的家庭医生中，48%知晓新的乙肝疫苗建议。然而，只有17%的人认为在他们的实践中所有新生儿都有必要接种。25%的人预计超过一半的家长会拒绝在一次儿童健康检查时接种三针疫苗，这是将这种疫苗添加到当前主要免疫接种计划中的结果。此外，42%的人预计护士会抵制在一次检查时接种三针疫苗。
疾病控制中心没有一个有效的机制向所有照顾儿童的医生传播信息。疾病控制中心与相关专业协会之间加强建议的协调，可能有助于提高医生在临床实践中采用新的免疫建议。此外，如果要成功实施新的免疫建议，在制定时必须考虑医生及其患者对多次注射和其他与实践相关问题所关注的实际问题。需要进一步研究以确定传播免疫信息的有效方法，并解决临床医生所关注的实际问题。
