BARRIERS TO IMMUNIZATION - AN EXAMINATION OF FACTORS THAT INFLUENCE THE APPLICATION OF PNEUMOCOCCAL VACCINE BY HOUSE STAFF

Pneumococcal infection is a leading cause of adult morbidity and morta lity in the United States. Immunization against this infection is a va luable strategy in preventive medicine. An effective pneumococcal vacc ine has been available in this country for over a decade, but it remai ns poorly utilized. The purpose of the present investigation was to an alyse the factors that affect the use and administration of the pneumo coccal vaccine and to identify barriers to use. Upper-level internal m edicine residents (n = 33) from two medical clinics associated with an academic medical centre completed an explanatory survey. This explore d the levels of house-staff knowledge, perception and attitudes regard ing the vaccine and the existence of practical barriers against its ut ilization. chi(2) analyses and z tests were carried out to determine s ignificance, where appropriate. The majority of the house staff (22, 6 6.7%) answered correctly regarding vaccine target groups, and all resi dents indicated that they generally obtain a vaccination history in ad ult patient evaluation. However, a sizeable number (14, 42.4%) did not indicate a time of the year when they routinely administered vaccines to patients. They were not confident about their knowledge regarding vaccine guidelines (23, 69.7%) and had an exaggerated fear of hypersen sitivity reactions from immunization (20, 60.6%). Neither the expense of the vaccine nor adverse publicity were impediments to immunization (24, 72.7% and 28, 84.8%, respectively). Although most physicians knew of the usefulness of the vaccine (31, 93.9%), many failed to translat e this knowledge into clinical practice (22, 66.7%). 'Pressing' clinic al issues were viewed as barriers to vaccination (18, 54.5%) and place d the practice of preventive medicine in a subordinate position. The r esults show that greater emphasis on prevention needs to be instituted in internal medicine residency programmes. The physicians in training need to be assured that the vaccine is safe and well tolerated by mos t patients for all practical purposes. Educational reinforcement may b e useful in enhancing resident confidence in vaccine usage.