Bordley W C, Margolis P A, Lannon C M
Department of Pediatrics, University of North Carolina at Chapel Hill, 27599-7225, USA.
Pediatrics. 1996 Apr;97(4):467-73.
To measure the proportion of children cared for in private practices who are fully immunized and have been screened for anemia, tuberculosis (TB), and lead poisoning by 2 years of age.
Cross-sectional chart review.
Fifteen private pediatric practices in central North Carolina (11 chosen randomly).
One thousand thirty-two randomly selected 2-year-old children.
Proportion of children immunized and screened for anemia, TB and lead poisoning by 24 months of age and immunization and screening rates of the practices.
Sixty-one percent of the children were fully immunized at 24 months of age; the rates among practices varied widely (38% to 82%). Sixty-eight percent of the children had been screened for anemia, 57% had been screened for TB, and 3% had been screened for lead poisoning. Physicians overestimated the proportions of fully immunized children in their practices by an average of 10% (range, -3% to 17%). The median number of well child visits by 2 years of age was 5 (range, 0 to 14), and only 19% of the entire sample made 8 or more well child visits, the number recommended by the American Academy of Pediatrics in the first 18 months of life. The numbers of well child and non-well child visits were the strongest predictors of complete immunization. Practice characteristics associated with being fully immunized included the use of preventive services prompting sheets (eg, flow sheets) in the medical records, not seeing the same physician for all well child care, and having nurses review patients' immunization status during their visits to the office.
Underimmunization and inadequate screening are significant problems in private pediatric practices in North Carolina. Physicians are unaware of the rates of underimmunization in their offices.
测定在私人诊所接受护理的2岁儿童中完全免疫且接受过贫血、结核病（TB）和铅中毒筛查的比例。
横断面图表回顾。
北卡罗来纳州中部的15家私人儿科诊所（随机选择11家）。
随机选取的1032名2岁儿童。
24个月龄时免疫且接受贫血、TB和铅中毒筛查的儿童比例以及诊所的免疫和筛查率。
61%的儿童在24个月龄时完全免疫；各诊所的免疫率差异很大（38%至82%）。68%的儿童接受过贫血筛查，57%接受过TB筛查，3%接受过铅中毒筛查。医生对其诊所中完全免疫儿童的比例平均高估了10%（范围为-3%至17%）。2岁时健康儿童就诊的中位数为5次（范围为0至14次），整个样本中只有19%的儿童进行了8次或更多次健康儿童就诊，这是美国儿科学会在前18个月建议的就诊次数。健康儿童和非健康儿童的就诊次数是完全免疫的最强预测因素。与完全免疫相关的诊所特征包括在病历中使用预防性服务提示单（如流程图）、并非所有健康儿童护理都由同一位医生进行以及护士在患者就诊时审查其免疫状态。
免疫不足和筛查不充分是北卡罗来纳州私人儿科诊所中的重大问题。医生并不了解其诊所中的免疫不足率。
