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首页> 美国卫生研究院文献>Annals of Family Medicine >Understanding Adult Vaccination in Urban Lower-Socioeconomic Settings: Influence of Physician and Prevention Systems
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Understanding Adult Vaccination in Urban Lower-Socioeconomic Settings: Influence of Physician and Prevention Systems

机译：了解城市低社会经济背景下的成人疫苗接种：医生和预防系统的影响

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>PURPOSE Vaccination rates for pneumococcal polysaccharide vaccine (PPV) and influenza vaccine are relatively low in disadvantaged urban populations. This study was designed to assess which physician and practice characteristics might explain differences in rates across physicians.>METHODS PPV and influenza vaccination rates were determined for 2,021 patients aged 65 years and older receiving care from 30 physicians in 17 practices surveyed about their office systems for providing adult immunizations. Hierarchical linear modeling (HLM) analyses were used to examine the relationships among vaccination rates, patient-level characteristics, and physician variables.>RESULTS Overall, the weighted PPV vaccination rate was 60.0% and varied widely across physicians (range, 11%–98%). At the patient level in HLM, patient race (P=.01) and age (P = .02), but not neighborhood income, were associated with PPV status. By linking physician survey data with PPV rates, we found the best pair of physician variables to be “reported time spent with patients for a well visit” (P = .01) and “use of enhanced immunization documentation” (P=.10). The overall influenza vaccination rate was 51.9% (range, 22%–96%). Patient race (P=.003) and age (P = .002) were associated with influenza vaccination. The pair of physician variables with the strongest association with influenza vaccination was “use of standing orders” (P <.001) and “average observed physician examination room time,” regardless of visit type (P=.02).>CONCLUSIONS Vaccination rates vary widely in urban settings and are associated with practice characteristics such as time spent with patients and, for influenza vaccine, use of standing orders.
机译：>目的在弱势的城市人群中，肺炎球菌多糖疫苗（PPV）和流感疫苗的接种率相对较低。这项研究旨在评估哪些医生和实践特征可能解释各医生之间的比率差异。>方法确定了20例65岁及以上年龄的2021名患者的PPV和流感疫苗接种率，这些患者在17种实践中接受了30名医生的护理调查了他们提供成人疫苗接种的办公系统。分层线性建模（HLM）分析用于检查疫苗接种率，患者水平特征和医生变量之间的关系。>结果总体而言，加权PPV疫苗接种率为60.0％，并且在医生之间差异很大（范围11％–98％）。在HLM的患者水平上，PPV状态与患者种族（P = .01）和年龄（P = .02）相关，而与邻里收入无关。通过将医师调查数据与PPV比率联系起来，我们发现最佳的医师变量对是“报告的患者用于一次良好就诊的时间”（P = .01）和“使用增强免疫证明文件”（P = .10） 。总体流感疫苗接种率为51.9％（范围为22％–96％）。患者的种族（P = .003）和年龄（P = .002）与流感疫苗接种有关。与门诊疫苗接种最相关的一对医生变量是“常规使用量”（P <.001）和“平均观察医生检查室时间”，而与访问类型无关（P = .02）。>结论疫苗接种率在城市环境中差异很大，并且与实践特征相关，例如与患者在一起的时间以及（对于流感疫苗而言）使用常规疫苗。

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