A NATIONAL SURVEY TO UNDERSTAND WHY PHYSICIANS DEFER CHILDHOOD IMMUNIZATIONS

Objective: To determine the causes of low childhood immunization rates based on physicians' knowledge, attitudes, and self-reported practice s concerning childhood immunization. Design: A standardized telephone survey conducted by trained interviewers. Setting: Primary care physic ians across the United States. Participants: A stratified random sampl e of office-based family physicians, pediatricians, and general practi tioners younger than 65 years was selected from the American Medical A ssociation master file list that includes nonmembers. Physicians seein g 5 or more patients per week younger than 6 years and having 50% or m ore primary care patients were eligible for study. Of 1769 eligible ph ysicians who spoke directly with the interviewers, 70% (N=1241) comple ted the questionnaire. Interventions: The interview was designed to de termine physicians' likelihood of recommending vaccination in common c linical scenarios and to probe reasons behind these decisions. Results : Only 4% of physicians who thought the risk for side effects was incr eased by upper respiratory tract infection (URI) were likely to vaccin ate a child with URI vs 55% of physicians who thought there would be n o increased risk (P<.001). Eighty-three percent of those who thought t he efficacy of measles, mumps, and rubella vaccine would not be affect ed by a URI recommended vaccination vs only 8% of physicians who thoug ht efficacy would decrease (P<.001). Some respondents (11%) would not administer 3 injectable vaccines simultaneously based on beliefs about side effects, parental objections, and vaccine efficacy. Physicians' likelihood of vaccination also varied by type of visit: 47% were less likely to vaccinate a child with a URI in an acute care as opposed to a well-child setting. Conclusion: Physicians' beliefs and practice pol icies materially influence their likelihood of recommending vaccinatio ns.