Freed G L, Freeman V A, Clark S J, Konrad T R, Pathman D E
Division of Community Pediatrics, University of North Carolina at Chapel Hill 27599-7590, USA.
J Fam Pract. 1996 Jun;42(6):587-92.
The purpose of this study was to assess (1) rates of agreement with and adoption of the universal hepatitis B vaccine recommendation among practicing pediatricians and family physicians in nine selected states; (2) physicians' attitudes related to hepatitis B immunization; and (3) physicians' perceptions of parental attitudes regarding the hepatitis B vaccine series.
Self-administered questionnaires were mailed to 3014 pediatricians and family physicians in selected metropolitan areas and non-metropolitan areas of nine states. Outcome variables were agreement with and adoption of the hepatitis B vaccine recommendation. Predictor variables included physicians' characteristics, practice type and location, and proportion of managed care and Medicaid patients. Other variables that were studied include physicians' attitudes related to hepatitis B immunization, sources of immunization recommendation information, personal completion of the hepatitis B immunization series, and physicians' impressions of parental attitudes about the vaccine.
Pediatricians were more likely than family physicians to report that they knew "a lot" about the recommendation (95% vs 84%), agreed with it (83% vs 57%), and have adopted it into practice (90% vs 64%). More physicians in both specialties had adopted the recommendation than actually agreed with it. Doubt about long-term protection from the vaccine was a strong predictor of not agreeing with or adopting the recommendation. Parental resistance to or request for hepatitis B vaccine affected the likelihood of physicians adopting it.
Pediatricians and family physicians continue to differ in both agreement with and adoption of universal hepatitis B immunization. Two years after the recommendation was made, less than two thirds of all family physicians have adopted this recommendation. Adoption is likely influenced by practice policy, physician attitudes, and perceived parental opinions. We recommend that as new vaccines are approved and recommended, research be conducted to explore and address issues germane to physician agreement and adoption.
本研究的目的是评估：（1）九个选定州的执业儿科医生和家庭医生对普遍接种乙型肝炎疫苗建议的认同率和采纳率；（2）医生对乙型肝炎免疫接种的态度；（3）医生对家长对乙型肝炎疫苗接种系列态度的看法。
向九个州选定的大都市地区和非大都市地区的3014名儿科医生和家庭医生邮寄了自填式问卷。结果变量为对乙型肝炎疫苗建议的认同和采纳情况。预测变量包括医生的特征、执业类型和地点，以及管理式医疗和医疗补助患者的比例。研究的其他变量包括医生对乙型肝炎免疫接种的态度、免疫接种建议信息的来源、个人完成乙型肝炎免疫接种系列的情况，以及医生对家长对疫苗态度的印象。
儿科医生比家庭医生更有可能报告他们对该建议“了解很多”（95%对84%）、认同该建议（83%对57%）并已将其纳入实践（90%对64%）。两个专业中更多的医生采纳了该建议，而非实际认同该建议。对疫苗长期保护作用的怀疑是不认同或不采纳该建议的有力预测因素。家长对乙型肝炎疫苗的抵制或要求影响了医生采纳该疫苗的可能性。
儿科医生和家庭医生在对普遍乙型肝炎免疫接种的认同和采纳方面仍然存在差异。该建议提出两年后，所有家庭医生中不到三分之二采纳了这一建议。采纳情况可能受执业政策、医生态度和家长意见的影响。我们建议，随着新疫苗获批并得到推荐，应开展研究以探索和解决与医生认同和采纳相关的问题。
