IMMUNIZATION PRACTICES OF PEDIATRICIANS AND FAMILY PHYSICIANS IN THE UNITED-STATES

Objective. To assess current practices and attitudes among pediatricia ns and family physicians across the United States regarding immunizati ons. Design. Survey of a random sample of pediatricians and family phy sicians. Subjects. Fellows of the American Academy of Pediatrics (N = 746) and American Academy of Family Medicine (N = 429). Survey topics. General immunization practices leg, types of visits during which vacc inations are provided, mechanisms to identify undervaccinated children ); and opinions about perceived barriers to immunizations, acceptance of alternative sites for immunizations, and possible immunization requ irements for Medicaid and The Special Supplemental Food Program for Wo men, Infants, and Children (WIC). Results. Pediatricians and family ph ysicians (combined) reported the following: immunizing children during acute illness visits (28%), follow-up visits (90%), and chronic illne ss visits (77%); using computer or reminder files to identify undervac cinated children (13%); and simultaneously administering four vaccines (diphtheria-tetanus-pertussis, oral poliovaccine, measles, mumps, and rubella and Haemophilus influenzae type b) to an eligible 18-month-ol d child (66%). Physicians perceived the following as barriers to immun izations: missed preventive visits (40%), vaccine costs (24%), lack of insurance coverage (24%), inability to track undervaccinated patients (22%), incomplete immunization records (12%), and missed vaccination opportunities (12%). Physicians agreed with offering vaccinations duri ng hospitalizations (51%) or emergency department visits (30%), and wi th immunization requirements for continued eligibility for Medicaid (6 6%) or WIC (64%). Pediatricians were more Likely to vaccinate during c hronic illness and follow-up visits, and were more likely to use syste ms to track undervaccinated children (P < .05); however, most immuniza tion practices and attitudes of pediatricians and family physicians we re similar. Physicians who graduated from medical school more recently and those in high-risk urban practices were more likely to vaccinate during acute illness visits, provide simultaneous vaccinations, and fa vor vaccinations in hospital settings. Conclusions. Vaccination rates might be improved by closer adherence to current immunization guidelin es regarding vaccinations during all encounters and simultaneous vacci nations, by developing systems to identify undervaccinated children, a nd by reducing patient costs for vaccinations. Current immunization pr actices fall short of the immunization guidelines; changes in individu al practice styles will be required to conform with these standards.