ARE IMMUNIZATIONS AN INCENTIVE FOR WELL-CHILD VISITS

Objective: To assess the beliefs of parents and the visit patterns of their children to determine whether immunizations act as an incentive to use well-child care. Design and Methods: Medical record audits prov ided data on immunizations and well-child visits. Two questions from a parent interview were used to identify 4 groups of parents: (1) motiv ated and (2) unmotivated to keep a well-child care appointment regardl ess of whether immunizations are scheduled, (3) vaccine-motivated and (4) checkup-motivated (parents who were influenced negatively by the p rospect of receiving vaccinations). The percentage of children with a visit at each age window for well-child visits and the percentage up-t o-date for their immunizations at given ages were compared across the 4 groups. The 4 groups were also compared for other parental attitudes about immunizations and well-child visits, and on sociodemographic an d access characteristics. Results: Most (73.3%) of the 502 parents sur veyed were classified as motivated and 5% as unmotivated to keep a wel l-child care appointment regardless of whether an immunization was sch eduled. Only 18.3% were categorized as vaccine-motivated and 3.4% as c heckup-motivated. For all 4 groups, there was no discernible differenc e in attendance between immunization and nonimmunization visits. Atten dance in the windows for well-child visits and percentage of children up-to-date on immunizations declined with increasing age. Conclusions: In this inner-city population, attendance patterns at visits did not support the incentive hypothesis. This finding should reassure clinici ans that providing immunizations outside of regular well-child care vi sits will not necessarily decrease attendance at visits for well-child care.