據(jù)4月25日刊《美國醫(yī)學會雜志》上的一項研究披露，與常規(guī)的醫(yī)療方式相比，一種通過給家長發(fā)送與教育有關的訊息短信的干預方法可在一個按照慣例難以聯(lián)系到的,、低收入的,、城市少數(shù)族裔的兒童及青少年人群中增加流感疫苗接種的覆蓋率,，盡管總體的覆蓋率仍然低下,。
紐約市哥倫比亞大學的Melissa S. Stockwell, M.D., M.P.H.及其同事評估了以低收入、城市中的家長為目標的,，宣傳在兒童和青少年中接種流感疫苗的短信的效果,。該隨機對照的試驗包括了9,213名年齡在6個月至18歲的兒童和青少年，他們于2010-2011流感季節(jié)在4家美國的以社區(qū)為基礎的診所中接受了治療,。在這9,213名兒童和青少年中,，有7,574人在該干預開始之日前沒有接受過流感的疫苗接種，他們被納入首要的分析之中,。被分到干預組的孩子的家長每周會收到多至5個免疫注冊相關的短信,，這些短信提供了教育性的資訊及有關周六診所的說明。
在這一研究中的兒童和青少年主要為少數(shù)族裔,，他們中88%的人具有公共保險，有58%的人來自說西班牙語的家庭,。截至2011年3月31日,，與常規(guī)治療組（39.9%）相比，干預組中的兒童和青少年有著較高的接種了流感疫苗的比例（43.6%）,。到這一日期為止,，在所有接種了疫苗的兒童和青少年中，在干預組中,，有93.9%的人是在周六診所之外接種疫苗的,，而在常規(guī)治療組中，這一比例為97.2%,。
在基于組群的秋季審查日時,，接種了流感疫苗的比例在干預組中為27.1% vs.常規(guī)治療組中為22.8%。
文章的作者寫道：“用短信來增加疫苗接種的覆蓋率有著眾多的優(yōu)點,。它可以聯(lián)系到龐大的人群,，而像流感疫苗這樣的建議為大多數(shù)人進行接種的疫苗，接種率只要有小幅的增加都可產(chǎn)生數(shù)目龐大的受到保護的個人,。它也可能很劃算,。這一系統(tǒng)一旦設立,，唯一的可變成本就是發(fā)送短信，而即便使用的是商用平臺,，其每則短信的成本也常常只需幾分錢,。因此，取決于人口的規(guī)模,，即使預先攤銷并監(jiān)控成本,，基于每一個人的發(fā)送短信的成本還是便宜的。”(生物谷：Bioon.com)
doi:10.1038/nbt.2149
PMC:
PMID:
Effect of a Text Messaging Intervention on Influenza Vaccination in an Urban, Low-Income Pediatric and Adolescent Population
Melissa S. Stockwell, MD, MPH; Elyse Olshen Kharbanda, MD, MPH; Raquel Andres Martinez, PhD; Celibell Y. Vargas, MD; David K. Vawdrey, PhD; Stewin Camargo, BS
Context Influenza infection results in substantial costs, morbidity, and mortality. Vaccination against influenza is particularly important in children and adolescents who are a significant source of transmission to other high-risk populations, yet pediatric and adolescent vaccine coverage remains low. Traditional vaccine reminders have had a limited effect on low-income populations; however, text messaging is a novel, scalable approach to promote influenza vaccination.
Objective To evaluate targeted text message reminders for low-income, urban parents to promote receipt of influenza vaccination among children and adolescents.
Design, Setting, and Participants Randomized controlled trial of 9213 children and adolescents aged 6 months to 18 years receiving care at 4 community-based clinics in the United States during the 2010-2011 influenza season. Of the 9213 children and adolescents, 7574 had not received influenza vaccine prior to the intervention start date and were included in the primary analysis.
Intervention Parents of children assigned to the intervention received up to 5 weekly immunization registry–linked text messages providing educational information and instructions regarding Saturday clinics. Both the intervention and usual care groups received the usual care, an automated telephone reminder, and access to informational flyers posted at the study sites.
Main Outcome Measures Receipt of an influenza vaccine dose recorded in the immunization registry via an electronic health record by March 31, 2011. Receipt was secondarily assessed at an earlier fall review date prior to typical widespread influenza activity.
Results Study children and adolescents were primarily minority, 88% were publicly insured, and 58% were from Spanish-speaking families. As of March 31, 2011, a higher proportion of children and adolescents in the intervention group (43.6%; n = 1653) compared with the usual care group (39.9%; n = 1509) had received influenza vaccine (difference, 3.7% [95% CI, 1.5%-5.9%]; relative rate ratio [RRR], 1.09 [95% CI, 1.04-1.15]; P = .001). At the fall review date, 27.1% (n = 1026) of the intervention group compared with 22.8% (n = 864) of the usual care group had received influenza vaccine (difference, 4.3% [95% CI, 2.3%-6.3%]; RRR, 1.19 [95% CI, 1.10-1.28]; P < .001).
Conclusions Among children and adolescents in a low-income, urban population, a text messaging intervention compared with usual care was associated with an increased rate of influenza vaccination. However, the overall influenza vaccination rate remained low.
Trial Registration clinicaltrials.gov Identifier: NCT01146912
