医联体模式下社区综合干预措施对社区居民流感疫苗接种率的影响

Effects of comprehensive community intervention under medical association model on the influenza vaccine coverage rate of community residents

目的评价医联体模式下以家庭医生为主体的社区综合干预措施对社区居民流感疫苗接种率的影响。方法本研究为社区干预实验研究。采用配额抽样法抽取上海市闵行区社区居民3000人,分为对照组和干预组,每组各1500人。对照组实施常规社区公共卫生管理,干预组在对照组基础上开展社区氛围群体干预和流感高危人群个体干预,随访1年(2019年7月至2020年6月)。分析2组居民全人群及流感高危人群干预前后的流感疫苗接种率的变化情况。结果对照组全人群、流感高危人群流感疫苗接种率管理前后差异均无统计学意义(χ^(2)值分别为0.26、0.00,P值均>0.05),而干预组干预后全人群、流感高危人群流感疫苗接种率均较干预前提高,差异均有统计学意义(χ^(2)值分别为34.80、32.84,P值均<0.001)。干预组干预后流感高危人群(去除年龄<5岁儿童)流感疫苗接种率较干预前提高,差异有统计学意义(χ^(2)=33.65,P<0.001),而对照组流感高危人群(去除年龄<5岁儿童)流感疫苗接种率管理前后差异无统计学意义(χ^(2)=1.16,P>0.05)。以家庭为单位,干预组干预后每户家庭流感疫苗接种人数较对照组增加,差异有统计学意义(Z=4.04,P<0.001)。干预组干预前未接种流感疫苗原因前三位是认为自己很健康没必要接种(40.00%,202/505)、之前没听说过流感疫苗(33.07%,167/505)、不知道何时何地去接种(29.32%,148/505),干预后未接种流感疫苗原因前三位是认为自己很健康没必要接种(42.58%,198/465)、流感是小病,不会造成严重后果(24.52%,114/465)、还有其他的防范措施(11.18%,52/465)。结论家庭医生在社区范围开展针对社区全人群的社区氛围和针对流感高危人群个体的综合干预措施,可明显提高全人群和流感高危人群的流感疫苗接种率。

Objective To evaluate the effects of comprehensive community intervention dominated by family doctors on the influenza vaccine coverage rate of community residents under the medical association model.Methods A total of 3000 community residents were recruited by quota sampling method and divided into control group and intervention group with 1500 people,respectively in the present study,an experimental study on community intervention.Routine community public health management was implemented for residents in the control group,and the community atmosphere group intervention on individual intervention on high-risk influenza population implemented for residents in the intervention group on the basis of the control group for one year.The residents were followed up for one year(extending from July 2019 to June 2020).The change in influenza vaccination rate of the whole population and high-risk influenza population from two groups of residents before and after intervention were analyzed.Results The difference in the influenza vacine vaccination rate of the whole population and high-risk population group in the control group wasn't statistically significant before and after administration(x^(2)was equal to 0.26 and 0.00 respectively,P>0.05).The vaccination rate of influenza vaccine in the whole population and high-risk influenza population in the intervention group was higher than that before the intervention.The difference was statistically significant(x^(2)was equal to 34.80 and 32.84,respectively,P<0.001).The difference in the influenza vaccine vaccination rate of high-risk population population(excluding children<5 years old)in the control group was not statistically significantly before and after administration(x^(2)=1.16,P>0.05).While the influenza vaccine vaccination rate of high-risk population population(excluding children<5 years old)in the intervention group was higher than that before intervention.The difference was statistically significant(x^(2)=33.65,P<0.001).The number of people vaccinated with influenza vacine in the intervention group with the family as the unit increased after intervention when compared with the control group,and the difference was statistically significant(Z=4.04,P<0.001).The top three reasons for failure to inoculate influenza vaccine in the intervention group before intervention were that the residents considered they were healthy and did not need to be vaccinated(40.00%,202/505),had never heard of influenza vaccine previously(33.07%,167/505)as well as did not know when and where to get vaccinated(29.32%,148/505),and the top three reasons for failure to inoculate influenza vaccine after intervention were that residents considered they were healthy and did not need to be vaccinated(42.58%,198/465),influenza was a minor illness that would not cause serious consequences(24.52%,114/465),and other preventive measures(11.18%,52/465).Conclusions The community atmosphere building dominated by family doctors under the mode of medical association and comprehensive community intervention measures for individuals at high risk of influenza is eligible to significantly improve the influenza vacine vaccination rate of the whole communityand high-risk influenza population.