MISSED OPPORTUNITIES IN PREVENTIVE PEDIATRIC HEALTH-CARE - IMMUNIZATIONS OR WELL-CHILD CARE VISITS

Objective.-To determine the percentage of patients in a large pediatri c practice in compliance with national recommendations regarding immun izations and well-child care visits. Research Design.-Chart review. Po int estimates with 95% confidence intervals were determined for review ed charts in compliance with recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control a nd Prevention and schedule of well-child care visits, screening and an ticipatory guidance recommended by the American Academy of Pediatrics (AAP). Setting.-A large, multisite urban public pediatric practice. Pa tients.-Three hundred eighty-six infants and children (aged 0 to 60 mo nths)who had a total of 7595 patient visits. Selection Procedures.-A r andom sample of charts. Results.-There was a large discrepancy in comp liance for patients aged 0 to 23 months in ACIP-recommended immunizati ons (90.5%+/-3.9%) vs AAP-recommended well-child care visits (37.6%+/- 6.4%) and for patients aged 24 to 60 months in ACIP-recommended immuni zations (87.8%+/-5.1 %) vs AAP-recommended well-child care visits (31. 0%+/-7.1%). Conclusions.-The data suggest that immunization alone does not ensure that children will receive all aspects of preventive care, raising questions about the practicality of the current AAP recommend ations for preventive pediatric health care.