The relation of parent and provider characteristics to vaccination status of children in private practices and managed care organizations in Maryland

OBJECTIVES. This study sought to identify provider practices and policies i n private pediatric settings that relate to vaccination status, controlling for the characteristics of the children served. METHODS. Vaccination data came from the medical records of 709 randomly sel ected 2-year-old children at 18 private practices and managed care organiza tions in Maryland, family data from 466 telephone interviews with the child ren's parents, and provider characteristics from 18 site questionnaires and 42 individual physician and nurse practitioner questionnaires. Logistic re gression and generalized estimating equations were used to estimate the rel ation of provider characteristics to vaccination status. Three age-appropri ate (AA) and two up-to-date (UTD) vaccination status variables characterize d successful vaccination. RESULTS. Approximately 70% of the study children were up-to-date by age 2 y ears for the full vaccination series, excluding hepatitis B vaccine. Family demographic characteristics were the strongest correlates of undervaccinat ion, Neither parents' knowledge and attitudes about immunization nor the ch ildren's insurance coverage was statistically related to vaccination status . Site reminder or follow-up systems and provider perceptions about appoint ment scheduling and receipt of vaccine information from health departments were positively related to vaccination. Concern for liability was associate d with a reduced odds of age-appropriate and up-to-date vaccination. CONCLUSIONS. Family demographics strongly correlate with vaccination status ; however, they are generally not modifiable, This study's findings encoura ge providers to operate a tracking system, to remain current on immunizatio n recommendations, to use all clinical encounters to screen and vaccinate c hildren, and to ensure the availability and convenience of vaccination serv ices.