FACTORS RESPONSIBLE FOR IMMUNIZATIONS REFERRALS TO HEALTH DEPARTMENTSIN NORTH-CAROLINA

Background. Despite the existence of Medicaid and other programs desig ned to eliminate cost as a barrier to immunization in physicians' offi ces, referrals to local health departments for immunizations are commo n. Many children leave their physicians' offices without receiving nee ded immunizations. Purpose. To determine: 1) the frequency and determi nants of immunization referrals to health departments in North Carolin a, and 2) the factors associated with private physicians' decisions to immunize Medicaid children in their offices and participate in the st ate-funded vaccine replacement program. Methods. The 2537 pediatrician s and family physicians licensed in North Carolina were surveyed by ma il using a 23-item, self-administered questionnaire. Results. Seventy- two percent of physicians responded; 93% referred at least some childr en to local health departments for immunizations. Concern regarding pa rents' ability to pay for immunizations was the most important reason for referral for 93% of respondents. Forty percent referred all or som e of their Medicaid patients; excessive paperwork, inadequate reimburs ement, and parental preferences were the most common reasons. Only 33% of physicians had participated in the state's vaccine replacement pro gram. Family physicians, and physicians in solo or two-physician pract ices in rural counties, and in practices caring for a small number of children on Medicaid were most likely to refer children covered by Med icaid and not participate in the state's existing vaccine replacement program. Conclusions. Medicaid and North Carolina's vaccine replacemen t program are not preventing large numbers of immunization referrals t o health departments. Future programs designed to increase the proport ion of children immunized in physicians' offices will not succeed if m ore effective incentives for physician participation are not developed .