Adolescent immunization practices - A national survey of US physicians

Background: Adolescent immunization rates remain low. Hence, a batter under standing of the factors that influence adolescent immunization is needed. Objective: To assess the adolescent immuization practices of US physicians. Design and Setting: A 24-item survey mailed in 1997 to a national sample of 1480 pediatricians and family physicians living in the United States, rand omly selected from the American Medical Association's Master List of Physic ians. Participants: Of 1110 physicians (75%) who responded, 761 met inclusion cri teria. Outcome Measures: Immunization practices and policies, use of tracking and recall, opinions about school based immunizations, and reasons for nut prov iding particular immunizations to eligible adolescents. Results: Seventy-nine percent of physicians reported using protocols for ad olescent immunization, and 82% recommended hepatitis B immunization for all eligible adolescents. Those who did not routinely immunize adolescents oft en cited insufficient insurance coverage for immunizations. While 42% of ph ysicians reported that they review the immunization status of adolescent pa tients at acute illness visits, only 24% immunized eligible adolescents dur ing such visits. Twenty-one percent used immunization cracking and recall s ystems. Though 84% preferred that immunizations be administered at their pr actice, 71% of physicians considered schools, and 63% considered teen clini cs to be acceptable alternative adolescent immunization sites. However many had concerns about continuity of care fur adolescents receiving immunizati ons in school. Conclusions: Most physicians supported adolescent immunization efforts. Bar riers preventing adolescent immunization included financial barriers, recor d scattering, lack of tracking and recall, and missed opportunities. School -based immunization programs were acceptable to most physicians, despite co ncerns about continuity of care. Further research is needed to determine wh ether interventions that have successfully increased infant immunization ra tes al e also effective for adolescents.