Zimmerman R K, Schlesselman J J, Mieczkowski T A, Medsger A R, Raymund M
Department of Family Medicine and Clinical Epidemiology, School of Medicine, University of Pittsburgh, Pa., USA. zimmer+@pitt.edu
Arch Pediatr Adolesc Med. 1998 Jan;152(1):12-9. doi: 10.1001/archpedi.152.1.12.
To understand physician concerns about litigation and beliefs regarding vaccine safety.
A stratified random sample of family physicians, pediatricians, and general practitioners younger than 65 years who were in office-based practices across the United States was selected from the American Medical Association list that includes nonmembers. A standardized telephone survey was conducted by trained interviewers in 1995.
Physicians seeing 5 or more patients per week younger than 6 years and having 50% or more primary care patients were eligible for the study.
Of the 1236 physicians who were surveyed, 32% and 13% overestimated the risk for serious adverse effects related to pertussis and measles vaccines, respectively. Among physicians who thought that serious adverse effects from diphtheria and tetanus toxoids and pertussis vaccine (DTP) were unlikely, 15% were highly concerned about litigation; however, among those with higher ratings of the likelihood of serious adverse effects, 38% were highly concerned about vaccine litigation (P < .01). Of those aware of the Vaccine Injury Compensation Program, only 41% believed that it afforded a high level of liability protection; 22% believed that it gives little protection, and 37% gave an intermediate answer. Among physicians highly concerned about vaccine litigation, 22% were unlikely to recommend the third dose of DTP for a child with a fever of 39.4 degrees C and no other symptoms after the second dose of DTP, whereas among those expressing little concern about litigation, only 12% were unlikely to vaccinate (P < .05). Although some physicians were concerned about litigation, most (86%) encouraged vaccination even if a parent was argumentative about possible adverse effects.
Physicians' perceptions about the risk for adverse effects and protection afforded by the Vaccine Injury Compensation Program influence their concern about litigation and, to a lesser extent, their reported likelihood to administer immunizations.
了解医生对诉讼的担忧以及对疫苗安全性的看法。
从美国医学协会包含非会员的名单中，选取年龄小于65岁、在全美国从事门诊医疗工作的家庭医生、儿科医生和全科医生组成分层随机样本。1995年由经过培训的访员进行标准化电话调查。
每周诊治5名或更多6岁以下患者且50%或更多患者为初级保健患者的医生符合研究条件。
在接受调查的1236名医生中，分别有32%和13%高估了与百日咳疫苗和麻疹疫苗相关的严重不良反应风险。在认为白喉破伤风类毒素和百日咳疫苗（DTP）不太可能产生严重不良反应的医生中，15%非常担心诉讼；然而，在认为严重不良反应可能性较高的医生中，38%非常担心疫苗诉讼（P <.01）。在知晓疫苗伤害赔偿计划的医生中，只有41%认为该计划提供了高水平的责任保护；22%认为几乎没有保护作用，37%给出了中间答案。在非常担心疫苗诉讼的医生中，22%不太可能为在第二次接种DTP后体温达到39.4摄氏度且无其他症状的儿童推荐第三次接种DTP，而在对诉讼不太担心的医生中，只有12%不太可能进行疫苗接种（P <.05）。尽管一些医生担心诉讼，但大多数（86%）即使家长对可能的不良反应有争议也鼓励接种疫苗。
医生对不良反应风险以及疫苗伤害赔偿计划所提供保护的认知，影响他们对诉讼的担忧，在较小程度上也影响他们报告的进行免疫接种的可能性。
