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Frequency and erroneous usage of temporary medical exemptions and knowledge of immunization guidelines among some Miami-Dade County Florida providers

机译：佛罗里达州迈阿密戴德县的一些医疗服务提供者使用临时医疗豁免的频率和错误使用情况以及对免疫指南的了解

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Objective: We assessed knowledge and practices regarding immunization guidelines and the Florida Certificate of Immunization (DH-680) based on FL-DOH and CDC recommendations, to identify the cause of the increasing number of erroneously issued temporary medical exemptions (TME) among selected health care providers in Miami-Dade County Florida. Methodology: After reviewing immunization certificates from all public schools, a list of physicians who improperly issued 3 or more TMEs, defined as one given to a child who was up to date for their kindergarten and seventh grade requirements, was compiled. The DOH-Miami-Dade developed educational materials and questionnaires, and conducted face-to-face interviews and interventions during site visits to these providers (n = 134). Data was analyzed using SAS 9.2. Results: Of the 104 questionnaires completed, 4 (3.85%) had correct answers to all 10 vaccine knowledge and practice related questions, while 10(9.62%) had 7 or more incorrect answers. Frequently missed questions included: the required doses of varicella vaccine for seventh grade students entering the 2011-12 school year (86, 82.7%) and the proper scenario for issuing a TME (57, 54.8%). Conclusions: In order to eliminate the improper use of TMEs, long-term efforts are needed to provide immunization-related educational materials and trainings to the medical community regarding vaccinations. These findings also suggest a need for enhanced explanation in multiple languages on the current Florida Immunization Certificate. Due to enhanced surveillance and education, the number of TMEs for kindergarten and seventh grade students was reduced by 12% and 4.9%, respectively, during the 2011 and 2012 school year
机译：目的：我们根据FL-DOH和CDC的建议评估了有关免疫指南和佛罗里达免疫证书（DH-680）的知识和实践，以查明选定健康人群中错误签发的临时医疗豁免（TME）数量增加的原因佛罗里达迈阿密戴德县的医疗服务提供者。方法：在审查了所有公立学校的免疫证明后，汇编了一份清单，列出了不正确地颁发3种或3种以上TME的医生，这些TME是指针对幼儿园和七年级要求的最新儿童。 DOH-Miami-Dade开发了教育材料和问卷，并在对这些提供者的现场访问期间进行了面对面的采访和干预（n = 134）。使用SAS 9.2分析数据。结果：在完成的104份问卷中，有4份（3.85％）对所有10个疫苗知识和操作相关问题有正确答案，而10份（9.62％）有7个或更多不正确答案。经常遗漏的问题包括：进入2011-12学年的七年级学生所需的水痘疫苗剂量（86，82.7％）和签发TME的适当方案（57，54.8％）。结论：为了消除TME的不当使用，需要长期的努力为医学界提供有关免疫接种的教育材料和培训。这些发现还表明，有必要在当前的佛罗里达免疫证书上以多种语言进行增强解释。由于加强了监督和教育，2011年和2012学年，幼儿园和七年级学生的TME数量分别减少了12％和4.9％。

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