Hak E, van Essen G A, Stalman W A, de Melker R A
University of Utrecht, Department of General Practice, The Netherlands.
Fam Pract. 1998 Apr;15(2):138-43. doi: 10.1093/fampra/15.2.138.
Worldwide, population-based influenza vaccination strategies are being developed to trace, immunize and monitor high-risk persons efficiently. Computerized prevention modules may facilitate such a strategy in general practice.
We established the applicability of a computerized influenza prevention module and specifically addressed improvement of immunization coverage in high-risk patients during two consecutive influenza vaccination rounds after introduction of the module.
In this descriptive study, four computerized practices of the Utrecht General Practices Network, covering about 36000 patients, participated. In 1995, all patients with high-risk diseases were traced by relevant tags, ICPC- and ATC-codes, using the module. According to changed Dutch immunization guidelines in 1996, healthy elderly people over 65 years were also traced. Demographical and medical data included age, high-risk disease and vaccine uptake.
In October 1995, 3871 high-risk patients were identified (11% of population); overall vaccination coverage was 68%. Over one-third of these patients had not been indicated before. In between the two vaccination rounds, 1104 previously unknown patients with high-risk disease <65 years were found by means of the module's on-line status. In October 1996, 6889 persons, including 2308 healthy elderly, were indicated (19%), and vaccination coverage was 62%. Of 3477 patients whose high-risk diseases were documented in both vaccination rounds, an overall improvement of vaccination coverage from 71 % in 1995 to 76% in 1996 was observed (P < 0.05). Main improvements were found in elderly patients. Immunization rates were highest in those with more than one risk factor, lung or cardiac disease, and lowest in healthy elderly and patients under 65 years with lung, renal or other diseases.
Computerized prevention modules and CMRs may facilitate population-based prevention of influenza and the use should be further encouraged.
在全球范围内，正在制定基于人群的流感疫苗接种策略，以便有效地追踪、免疫和监测高危人群。计算机化预防模块可能有助于在全科医疗中实施这样的策略。
我们确定了计算机化流感预防模块的适用性，并特别关注在引入该模块后的连续两轮流感疫苗接种期间，提高高危患者的免疫接种覆盖率。
在这项描述性研究中，乌得勒支全科医疗网络的四个计算机化诊所参与其中，覆盖约36000名患者。1995年，使用该模块通过相关标签、国际初级保健分类（ICPC）和解剖治疗化学分类（ATC）代码追踪所有患有高危疾病的患者。根据1996年荷兰免疫指南的变化，65岁以上的健康老年人也被追踪。人口统计学和医学数据包括年龄、高危疾病和疫苗接种情况。
1995年10月，识别出3871名高危患者（占人口的11%）；总体疫苗接种覆盖率为68%。这些患者中有超过三分之一以前未被识别。在两轮疫苗接种之间，通过该模块的在线状态发现了1104名以前未知的65岁以下高危疾病患者。1996年10月，识别出6889人，包括2308名健康老年人（占19%），疫苗接种覆盖率为62%。在两轮疫苗接种中均记录有高危疾病的3477名患者中，观察到疫苗接种覆盖率从1995年的71%总体提高到1996年的76%（P<0.05）。主要改善见于老年患者。免疫接种率在有多个危险因素、肺部或心脏疾病的患者中最高，在健康老年人以及65岁以下患有肺部、肾脏或其他疾病的患者中最低。
计算机化预防模块和疾病监测登记系统可能有助于基于人群的流感预防，应进一步鼓励其使用。
