基于全科医护团队网格化管理对“家庭式流动”儿童免疫规划的影响

Influence of grid-based management of general medical team on “family-flowing” children’s immunization program

目的探讨基于全科医护团队网格化管理对社区“家庭式流动”儿童免疫规划的影响。方法采用便利抽样法从郑州市4个辖区(管城区、金水区、二七区、郑东新区)内5家社区卫生服务中心抽取660名0~6岁儿童的家长或监护人作为调查对象,现场发放调查问卷。调查“家庭式流动”儿童国家免疫规划(NIP)疫苗接种情况,包括卡介苗(BCG)、脊髓灰质炎疫苗(OPV)、百白破疫苗(DPT)、麻疹疫苗(MV)、乙肝疫苗(HepB)。统计基于全科医护团队网格化定位管理后“家庭式流动”儿童的计划免疫接种率。了解流动儿童未及时接种的原因。另抽查郑州市某社区2014—2018年流动儿童基础疫苗完成率和加强疫苗完成率。结果回收有效问卷616份,回收率为93.33%。外省户籍和无户籍流动儿童NIP疫苗接种率低于本省外市户籍流动儿童,外省户籍和无户籍流动儿童NIP疫苗接种率低于本市外区户籍的流动儿童,差异有统计学意义(均P<0.05)。流动儿童基础免疫接种率(BCG接种率、OPV接种率、DPT接种率、MV接种率、HepB接种率、五苗接种率、五苗合格率)均低于常住儿童接种率,差异有统计学意义(均P<0.05)。流动儿童未及时接种的主要原因为监护人工作忙而忘记接种程序及时间或没时间带儿童去接种。实施全科医护团队网格化管理后,2018年五苗全程接种率高于2014年五苗全程接种率,差异有统计学意义(P<0.05)。0~6岁流动儿童基础疫苗完成率和加强疫苗完成率呈现整体上升的趋势。结论流动儿童基础免疫疫苗接种率较低,特别是外省和无户籍的流动儿童。基于全科医护团队网格化定位管理流动儿童计划免疫接种,能有效促进流动儿童疫苗接种率的提高。

Objective To explore the impact of grid-based management of the general medical team on the “family-flowing” children’s immunization program in the community. Methods Through convenient sampling,660 parents or guardians of children aged 0 to 6 years old were selected from 5 community health service centers in 4 districts of Zhengzhou (Guancheng District,Jinshui District,Erqi District and Zhengdong New District) and questionnaires were distributed on the spot.To investigate the National Immunization Program (NIP) vaccination status of “family-flowing” children’s immunization program,including BCG,OPV,DPT,MV and HepB.The planned immunization coverage rate of children with “family-flowing” was calculated based on the grid positioning management of the general medical team.To understand the reasons why migrant children were not vaccinated in time.In addition,a survey was conducted on the completion rate of basic vaccines and the completion rate of enhanced vaccines for migrant children in a community in Zhengzhou from 2014 to 2018. Results A total of 616 valid questionnaires were recovered,and the recovery rate was 93.33%.The NIP vaccination rates of the children registered in other provinces and without household registration were lower than that of migrant children in other cities in Henan Province,and the NIP vaccination rates of the children registered in other provinces and without household registration were lower than that of migrant children in other districts of the city,while the differences were statistically significant (all P < 0.05).The basic immunization rate of migrant children (BCG vaccination rate,OPV vaccination rate,DPT vaccination rate,MV vaccination rate,HepB vaccination rate,five seedling vaccination rate,and five seedling pass rate) were lower than the vaccination rates of resident children,with the differences statistically significant (all P < 0.05).The main reason why migrant children were not vaccinated in time was that the guardians were busy with work and had forgot the vaccination procedures and time or had no time to take the child to vaccinate.After the implementation of grid management of general medical team,the overall vaccination rate of five NIP vaccines in 2018 was higher than that in 2014,and the difference was statistically significant ( P < 0.05).The completion rate of basic vaccines and the completion rate of enhanced vaccines for migrant children aged 0 to 6 years old showed an overall upward trend. Conclusion The vaccination rate of basic immunization for migrant children is relatively low,especially for migrant children from other provinces and those without household registration.Based on the grid positioning of the general medical team to manage the planned immunization of migrant children,it could effectively improve the vaccination rate of migrant children.