干预行为使流感疫苗接种人数在1年内翻番

BALTIMORE (EGMN) – A three-pronged intervention to increase influenza vaccination rates in high-risk pediatric patients doubled the number of patients who were vaccinated in just 1 year.

Some of the lessons learned: Start planning for flu season long before it actually begins, and be creative with scheduling to allow for weekend and evening hours, Dr. Zeina M. Samaan said at the annual meeting of the Pediatric Academic Societies.

Dr. Samaan, a pediatrician at Cincinnati Children’s Hospital Medical Center, said that before intervention, in the 2006-2007 flu season, 72% of the asthma patients and 68% of the children aged 6-59 months old who were seen at an inner city pediatric primary care clinic received an influenza immunization.

After intervention, in the 2007-2008 flu season, 84% of the asthma target population was immunized, as were 89% of patients aged 6-59 months. Those rates stayed about the same during the 2008-2009 flu season.

In total, in 2009, 2,203 asthma patients and 4,665 patients aged 6-59 months were vaccinated. In contrast, in 2007, there were 1,120 asthma patients and 1,760 patients aged 6-59 months who were vaccinated.

The interventions fell into three general categories, according to Dr. Samaan.

The first tactic was to increase access for patients. “Throughout the flu season, from October through March, we had – every day – 30 appointments for a flu shot, only offered as a nurse visit,” said Dr. Samaan. “And even though the majority of our visits are by appointment, we also accommodated those patients who walked in our clinic and asked for a flu vaccine.” The practice also organized a walk-in flu shot clinic every Saturday throughout the flu season.

“We also trained our ... staff to register and immunize siblings,” she added.

The second part of the intervention involved clinical decision support. Using the electronic health records system that has been in place at her practice for about 5 years, Dr. Samaan and her staff programmed the computers – which are located in every exam room – to automatically open a reminder window. “When a patient comes in and meets the criteria for a flu vaccine, an alert will fire,” she said.

Additionally, on every visit, when the triage nurse triaged the patient, the nurse was trained to ask whether the patient had received the flu vaccine. If the patient hadn’t been vaccinated, the nurse would offer the vaccine, and document whether the patient got the vaccine or refused it. “So when the physicians opened the chart, [if the patient had refused the vaccine], they would see it on the chief complaint, and be reminded to offer it [again],” said Dr. Samaan. The staff also was trained to request a flu shot if the provider forgot to order it.

The third portion of the intervention involved patient education. Previously, Dr. Samaan’s clinic had sent out postcard reminders to patients about flu vaccine at the start of the season, “and we’d get half of them returned with the wrong address,” she said. This year, thanks to some early planning, “when the families came in for a visit a few months before the flu season started, we gave them a flu reminder card, and asked them to fill it with the most recent address or the best address at which we could reach them.” When the season began, the practice mailed the cards, “and we had very few returned to us this year with the wrong address,” she said.

Posters about the flu vaccine were hung in the waiting room and exam rooms, as well as in the physician break rooms and even the bathrooms.

Finally, the staff also attended bimonthly meetings with other outpatient clinics in the area to “learn about strategies and share ideas and experiences,” she said.

Although the clinic fell short of its goal to immunize 95% of the high-risk patients, the intervention was relatively cheap, with the greatest expense being staffing at the Saturday clinics for the “huge number” of patients who showed up. Her staff is already working on techniques to further increase rates this 2009-2010 flu season, she said.

The session moderator also pointed out that the same strategies could be shared with the adult medicine world, “since their immunization rates are much worse than our rates in children.”

Dr. Samaan said that she had no conflicts of interest to disclose.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

巴尔的摩 (EGMN) ——通过对高危儿童患者进行3个方面的干预，接种流感疫苗患者的数量在短短一年内已经翻了一番。

Zeina M. Samaan医师在儿科学术协会的年会上宣布，我们由此汲取的经验是应当早在流感季节真正到来之前就开始做好准备，并增加周末和夜间服务，创造性地安排接诊时间。

Samaan是一名儿科医师，供职于辛辛那提儿童医院医疗中心。她说：在进行这些干预之前，2006~2007年度的流感季节中，有72%哮喘患者和68%在市中心儿科初级医疗诊所诊治的6~59月龄儿童接种了流感疫苗。

而在进行干预之后，2007~2008流感季节中，哮喘目标人群的84%以及6~59月龄儿童的89%接受了免疫接种，2008~2009流感季的数字基本与此持平。

今年总共有2,203名哮喘患者和4,665名6~59月龄儿童进行了免疫接种。 相比之下，2007年接受免疫接种的只有1,120名哮喘患者和1,760名6~59月龄儿童。

Samaan医师表示，干预分为3个方面：

第1方面就是增加接诊患者数量。“在从10月到次年3月的流感季节中，我们每天有30个注射流感疫苗专用的预约，只派护士进行处理；虽然大部分接诊都是需要预约，我们也会接待未预约而直接上门要求注射疫苗的患者。”在流感季节中，诊所在每周六也为未预约者注射流感疫苗。

她表示，“我们也对员工进行培训，让他们给自己的兄弟姐妹进行登记和免疫接种。”

干预的第2方面是临床决策支持。Samaan医师及其员工使用电子健康记录系统已有5年，他们对每间房间的电脑进行编程，使其可以自动打开一个提示窗口。“当一名就诊患者具有注射流感疫苗的指征时，提示就会开启。”

另外，在分诊台接诊的护士也接受了相关培训，询问每名患者是否注射过流感疫苗。如果患者未接种，护士将会提供疫苗并记录该患者接受或是拒绝注射。“所以当医师打开病历，如果患者拒绝接受疫苗注射，将可在主诉上看到此信息，再次提醒医师提供疫苗。”即使主治医师忘记了，其他员工也会提醒患者进行疫苗接种。

干预的第3方面是患者宣教。过去，Samaan医师的诊所会在流感季节开始时向患者邮寄明信片，以提醒他们进行流感疫苗注射。“但半数的明信片都因地址错误而退回。”今年由于进行了提前策划，“当一些家庭在流感季节开始前几个月来就诊时，我们就给他们一张流感提示卡片，并嘱其在上面填写最新地址或能联系到他们的最佳地址。”当流感季节开始时，诊所将邮寄这些卡片，“今年我们就很少收到因地址错误而退回的卡片。”她解释说。

关于流感疫苗的宣传海报被贴在了候诊室、检查室和医师休息室甚至卫生间。

最后，员工参加每2月1次的例会，同本地区其他门诊诊所的同行一起“学习应对策略，分享想法和交流经验。”

虽然诊所并未达到给95%高危患者都进行免疫的目标，但这种干预方法的成本相对较低。而且最大部分的开支都花费在周六接待“大量”来访患者的工作人员身上。她说，她手下的员工已经在努力学习技术，以期在2009~2010年流感季节进一步提高疫苗接种率。

会议主持人同时指出，同样的策略可应用于成人医疗领域，“因为成人的疫苗接种率比儿童的低得多。”

Samaan医师声明没有任何利益冲突。

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