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일차진료에서 폐렴 고위험군 환자들의 13가 단백접합 백신 접종률을 높이기 위한 의사의 구두 권고 중요성

Impact of a Doctor's Verbal Recommendation on Pneumococcal 13-Valent Conjugate Vaccine among High-Risk Patients for Pneumonia in a Primary Care Setting

김종성|이사미|김지한
대한임상건강증진학회 (Korean Society For Health Promotion And Disease Prevention)|2021.03|Korean Journal of Health Promotion|제21권 제1호|pp. 8-16

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키워드

교육VaccinationHealth education예방접종폐렴PneumoniaDirective counseling13가 폐렴구균 백신지도상담13-valent pneumococcal vaccine
주제분류기타자연과학

초록

연구배경: 한국에서 지역사회획득 폐렴의 주요 세균성 원인균은 폐렴구균으로 알려져 있다. 폐렴을 예방하기 위해서는 폐렴구균 백신 예방접종이 중요한데, 본 연구는 폐렴 백신 예방접종률을 높이기 위해 의사의 권고 방법에 따른 예방접종률의 차이가 있는지를 확인하고자 하였다. 방법: 1차 의료기관 외래에 내원한 초진 환자 중 폐렴 고위험군 환자 143명의 의무기록을 후향적으로 분석하였다. 폐렴 고위험군은 미국 예방접종 자문위원회에서 제시한 내용에 따라 정의하였다. 초진 당시 이전에 13가 폐렴구균 백신(PCV13) 예방접종을 실시한 16명을 제외하고 127명에 대해 진료 중에 실시한 예방접종 권고 방법에 따라(배너군, 배너+브로셔군, 배너+브로셔+의사의 권고군) PCV13 예방접종률에 차이가 있는지 비교 분석하였다. 결과: 초진 당시 폐렴 고위험군 환자 중 권고 전 PCV13 접종률은 11.2%에 불과하였지만, 권고 후 예방접종률은39.2%까지 증가하였다(P<0.001). 그중 배너군(B)은 9.0%, 배너+브로셔군(B+Br)은 20.0%, 배너+브로셔+의사의 권고를 받은 군(B+Br+DR)은 75.0%로 접종률의 차이를 보였다(P<0.001). 나이, 성별, 고위험군, 직업, 거주지역을 보정하여 회귀분석을 시행한 결과 PCV13 예방접종률에 대한 오즈비(OR)는 B군과 비교하여 B+Br군은 2.49 (95% CI, 0.55-11.34), B+Br+DR군은 43.72 (95% CI, 11.52-165.96)로확인되었다. 결론: 폐렴 고위험군 환자에서 권고 방법에 따라 상이한예방접종률을 보였다. 다양한 방법들이 있지만 본 연구를통해 실제 진료 상황에서 의사의 구두 권고를 병행하는 것이 가장 효과적인 방법 중 하나라고 생각한다.

Abstract

Background: Streptococcus pneumoniae is the main bacterial pathogen of community-acquired pneumonia in Korea. This study aimed to enhance the vaccination rate by evaluating the effectiveness of current methods of recommendation. Methods: A retrospective analysis of the medical records of 143 patients with high risk of pneumonia among first-visit outpatients was conducted. High-risk patients for pneumonia are defined by the U.S. Advisory Committee on Immunization Practices. One hundred and twenty-seven patients, excluding 16 with pneumococcal 13-valent conjugate vaccination (PCV13) history prior to the first visit, were divided into three groups according to the method of vaccination recommendation: banner (B) group; banner+brochure (B+Br) group; banner+ brochure+doctor's recommendation (B+Br+DR) group. The vaccination rates among patients in each group were compared. Results: Patients with high risk of pneumonia showed 11.2% rate for PCV13 vaccination upon their first visit; however, this rate increased to 39.2% following counseling (P<0.001). Variation among the three groups was as follows: 9.0% in the B group, 20.0% in the B+Br group, and 75.0% in the B+Br+DR group (P<0.001). After adjusting for age, sex, high-risk group, occupation, and residence, a regression analysis was carried out. The odds ratio for the PCV13 vaccination rate compared to the B group was 2.49 (95% confidence interval [CI], 0.55-11.34) for the B+Br group and 43.72 (95% CI, 11.52-165.96) for the B+Br+DR group. Conclusions: Among the available methods, we are thought to be more effective to add doctor's verbal recommendation in a clinical setting.

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