Relationship be-tween primary payer and use of proactive immunization practices: A-national survey

Objective: To quantify the national use and determinants of proactive immun ization practices by examining the relationship to the primary practice pay er. Study Design: A standardized survey was conducted in 1995 by trained person nel using computer-assisted telephone interviewing. Patients and Methods: A stratified random sample of family physicians, pedi atricians, and general practitioners across the United States was selected from the American Medical Association master file of physicians list, which included nonmembers. The main outcome measures were use of reminder system s and assessment of immunization rates. Results: Of the 1769 physicians who were contacted, 1236 participated. Use of reminder systems varied by the practice's primary payer: 31% of health m aintenance organization (HMO), 41% of Medicaid, 27% of fee-for-service (FFS ), and 28% of no predominant payment source physicians reported using a rem inder system (P < 0.01). Use of computerized reminders also varied accordin g to practice primary payer (HMO, 68%; Medicaid, 34%; FFS, 51%; and no pred ominant payment source, 42%; P < 0.01) as did assessment of immunization ra tes in the practice (HMO, 57%; Medicaid, 40%; FFS, 28%; and no predominant payment source, 30%; P < 0.01). A majority of Medicaid physicians (84%) req uired a physical examination before immunization, compared to 49% of HMO, 5 6% of FFS, and 63% of no predominant source physicians (P < 0.01). Conclusions: The primary payment source of a practice appears to influence use of proactive immunization practices.