EFFECT OF THE VACCINES FOR CHILDREN PROGRAM ON INNER-CITY NEIGHBORHOOD PHYSICIANS

Objective: To determine the probable effect of the Vaccines for Childr en (VFC) program on immunization coverage. Design: Preintervention and postintervention study design, with data collected before and after e nrollment in the VFC program. Setting: Twenty-three inner-city neighbo rhood physicians' offices in New York City. Participants: In 1993, 30 physicians were randomly selected from 8 neighborhoods with the highes t proportions of Medicaid-eligible individuals in New York City. In 19 95-1996, the 30 physicians were contacted again. Twenty-three agreed t o an interview and medical rec ord review. Within each office, the med ical records of children aged 3 to 35 months, with at least 3 visits i n a 3-month or longer period, were randomly selected. Medical record r eviews were conducted for 173 eligible children in 1993 and 528 in 199 5-1996. Interventions: The VFC program was implemented in October 1994 . The administration fee increased from $2 to $17.85; physicians recei ved vaccines free. Main Outcome Measures: Up-to-date status for immuni zations and lead and tuberculosis screening; percentage of visits that are missed opportunities to immunize; and percentage of visits that w ere well-child visits. Up-to-date status, missed opportunities to immu nize, and well-child visits were compared across time using chi(2) ana lysis, corrected for the use of cluster sampling. Results: Up-to-date status changed significantly before and after enrollment in the VFC pr ogram (P<.05) for all immunizations and for lead and tuberculosis scre ening. For the diphtheria toroid, tetanus toroid, and pertussis vaccin e, oral poliovirus vaccine, and measles, mumps, and rubella vaccine co mbined, coverage increased from 17.9% to 42.2%, up by 24.3 percentage points (P<.05). Missed opportunities to immunize did not change, but w ell-child visits increased from 15.0% to 21.6% (P<.05). Physicians gen erally attributed performance improvements to the VFC program and not to other competing hypotheses. Conclusions: The VFC program seems to b e responsible for an increase in immunization rates among these physic ians.