Waterman S H, Hill L L, Robyn B, Yeager K K, Maes E F, Stevenson J M, Anderson K N
County of San Diego Department of Health Services, California, USA.
Am J Prev Med. 1996 Jul-Aug;12(4 Suppl):8-13.
An immunization demonstration project was conducted in an inner-city Latino neighborhood in San Diego to address underimmunization of children of preschool age. The project attempted interventions on consumer, provider, and system levels to reduce barriers to immunization and raise immunization rates. Free walk-in immunization clinics with emphasis on cultural sensitivity and that incorporated computerized reminder/recall were established. An educational series was offered to community health center (CHC) providers, and extensive community-based outreach and education took place in schools, churches, a WIC site, etc. Evaluation activities included preintervention and postintervention provider knowledge, attitudes, and practice surveys, CHC chart audits, and household surveys in the intervention ZIP code area and a control ZIP code area. Immunization coverage for 4DPT, 3OPV, and 1MMR (4:3:1) among two-year-olds increased significantly from 37% to 50% overall, and to 59% in the 1991 birth cohort in the intervention area compared to a one percentage point overall increase in the control area. Coverage improved significantly and missed opportunities decreased in one intervention CHC that participated most actively in educational inservices. While the Year 2000 U.S. Public Health Service objective of 90% 4:3:1 coverage for two-year-olds was not achieved over the 21-month course of the project, the results approached the 1996 single-antigen objectives. This demonstration underscores the importance of multilevel interventions including low cost, no appointment, and culturally appropriate immunization services for the indigent; the use of computerized reminder systems; and provider assessment, education, and feedback in the effort to raise preschool immunization levels. Medical Subject Headings (MeSH): immunization, preschool-age children, health promotion, provider education, immunization monitoring and follow-up systems, pediatric immunization standards, household surveys.
在圣地亚哥一个市中心的拉丁裔社区开展了一项免疫示范项目，以解决学龄前儿童免疫接种不足的问题。该项目尝试在消费者、提供者和系统层面进行干预，以减少免疫接种的障碍并提高免疫接种率。设立了强调文化敏感性并采用计算机化提醒/召回系统的免费即到即种免疫诊所。为社区卫生中心（CHC）的提供者提供了一系列教育活动，并在学校、教堂、一个妇女、婴儿和儿童营养补充计划（WIC）站点等场所开展了广泛的社区外展和教育活动。评估活动包括干预前和干预后对提供者知识、态度和实践的调查、CHC图表审计，以及在干预邮政编码区域和对照邮政编码区域进行的家庭调查。总体而言，两岁儿童中4剂百白破疫苗（4DPT）、3剂口服脊髓灰质炎疫苗（3OPV）和1剂麻疹、腮腺炎、风疹联合疫苗（1MMR）（4:3:1）的免疫接种覆盖率从37%显著提高到50%，在干预区域，1991年出生队列中的覆盖率提高到59%，而对照区域总体仅提高了1个百分点。在最积极参与教育在职培训的一个干预CHC中，覆盖率显著提高，错失的机会减少。虽然在该项目21个月的实施过程中未实现美国公共卫生服务部2000年设定的两岁儿童90%的4:3:1免疫接种覆盖率目标，但结果接近1996年的单抗原目标。该示范项目强调了多层次干预措施的重要性，包括为贫困人口提供低成本、无需预约且符合文化习惯的免疫服务；使用计算机化提醒系统；以及在提高学龄前免疫接种水平的努力中对提供者进行评估、教育和反馈。医学主题词（MeSH）：免疫接种、学龄前儿童、健康促进、提供者教育、免疫接种监测与随访系统、儿科免疫接种标准、家庭调查。
