REDUCING MISSED OPPORTUNITIES TO VACCINATE DURING CHILD HEALTH VISITS- HOW EFFECTIVE ARE PARENT EDUCATION AND CASE-MANAGEMENT

Background: At child health visits, immunizations that are due are fre quently not given. Increased parent understanding of and demand for im munizations may influence providers to not miss these opportunities. O bjective: To assess, as part of a larger study of effectiveness of par ent education and case management (CM) in raising immunization rates, the intervention's effectiveness at reducing missed opportunities to v accinate during child health visits. Methods: A representative sample of African American newborns and their families from south central Los Angeles, Calif, were randomly assigned to a control or a CM group and observed during the first year of life, Case managers visited and tel ephoned parents, educating them on the benefits and safety of immuniza tions, and encouraging them to request immunizations from providers. W hen the children were at least 1 year of age, parents were interviewed and presider records were abstracted. Results: Complete records were abstracted for 126 controls and 129 CM soup children. For these childr en, 1092 visits were documented where immunizations were due, Missed o pportunities to vaccinate occurred at more than 50% of visits. Case ma nagement was associated with a modest reduction in the percentage of v isits with missed opportunities in the bivariate analysis but not afte r adjustment for other covariates. In a logistic regression model, mis sed opportunities were more frequent at visits with private than publi c physicians and at acute illness than well-child visits. Missed oppor tunities were less frequent among children with a history of at least 1 cancelled appointment, and for visits of children with mothers who s moked. Conclusions: Missed opportunities were minimally influenced by a home visitation and parent education program. They are primarily det ermined by issues under the control of the provider. Family-and child- related characteristics, however, do influence the likelihood of a mis sed opportunity occurring independent of provider factors.