PEDIATRICS Vol. 99 No. 2 February 1997, pp. 209-215
The Influence of Provider Behavior, Parental Characteristics, and a Public Policy Initiative on the Immunization Status of Children Followed by Private Pediatricians: A Study From Pediatric Research in Office Settings
Received Oct 3, 1995; accepted Mar 19, 1996.
,
From the * Department of Pediatrics, University of Washington,
Seattle; Department of Pediatrics, Medical University of South
Carolina, Charleston; § Pediatric Research in Office Settings, American
Academy of Pediatrics, Elk Grove Village, Illinois; and Department
of Pediatrics, University of Vermont College of Medicine, Burlington.
Objectives. To determine the relative impact of parental characteristics, provider behavior, and the provision of free vaccines through state-sponsored vaccine volume programs (VVPs) on the immunization status of children followed by private pediatricians.
Study Design. Retrospective and cross-sectional surveys of immunization data.
Setting. The offices of 15 private pediatricians, from 11 states, who were members of the Pediatric Research in Office Settings network. Seven of these physicians used vaccines provided through VVPs.
Patients. Children 2 to 3 years old followed by the participating physicians.
Methods. The immunization status of children was assessed from two separate samples. For sample 1, immunization data were abstracted from the medical records of 60 consecutive eligible children seen in each office. Parents of the selected children indicated the method of payment for immunizations and the education levels of the mothers. Because this cross-sectional survey might have oversampled frequent health care users, a retrospective chart review of up to 75 randomly selected children in each pediatrician's practice was also conducted (sample 2). Additional data were collected from the parents of children in sample 2 by telephone interviews. For both samples, patients were considered to be fully immunized if they had received four diphtheria-tetanus-pertussis/diphtheria-tetanus vaccines, three oral poliovirus/inactivated poliovirus vaccines, and one measles-mumps-rubella vaccine before their second birthdays. Before collecting vaccination data, pediatricians completed a survey detailing their immunization beliefs and practices. Logistic regression was used to identify factors that were independently associated with a child being fully immunized.
Results. For sample 1, 81.7% of the 857 children surveyed were fully immunized. Practitioner-specific immunization rates varied widely, ranging from 51% to 97%. The immunization rate of children who received vaccines provided by VVPs was similar to that of children whose immunizations were not provided by VVPs (81.2% vs 82.2%; odds ratio [OR] for a VVP as a predictor for being fully immunized, 0.94, 95% confidence interval [CI], 0.66 to 1.32). In addition, parents who paid for immunizations out of pocket were as likely to have fully immunized children as those who had little or no out-of-pocket expenditures for vaccines (OR, 1.13; 95% CI, 0.75 to 1.13). In the logistic model, only individual pediatrician and size of the metropolitan area in which the pediatrician's practice was located were significant predictors of a child's immunization status. The results from sample 2 were similar; 82.1% of the 772 surveyed patients were fully immunized. With sample 2, individual pediatrician and age of the child at the time of the survey were the only predictors of immunization status. The OR of a VVP as a predictor of a child being fully immunized was 1.37 (95% CI, 0.65 to 2.90).
Conclusions. Individual provider behavior may be the most important determinant of the immunization status of children followed by private pediatricians. In our samples, the effect of parental characteristics was limited. State-sponsored VVPs were not associated with higher immunization rates, perhaps because cost of vaccines did not seem to be a significant barrier to immunization in this population.
Key words: immunization, private pediatricians, provider behavior, vaccination.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  E. Borras, A. Dominguez, M. Oviedo, J. Batalla, and L. Salleras The influence of public or private paediatric health care on vaccination coverages in children in Catalonia (Spain) Eur J Public Health, January 1, 2009; 19(1): 69 - 72. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Smith, S. S. Ellenberg, L. M. Bell, and D. M. Rubin Media Coverage of the Measles-Mumps-Rubella Vaccine and Autism Controversy and Its Relationship to MMR Immunization Rates in the United States Pediatrics, April 1, 2008; 121(4): e836 - e843. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. E. Mercier, S. E. Barry, K. Paul, T. V. Delaney, J. D. Horbar, R. C. Wasserman, P. Berry, and J. S. Shaw Improving Newborn Preventive Services at the Birth Hospitalization: A Collaborative, Hospital-Based Quality-Improvement Project Pediatrics, September 1, 2007; 120(3): 481 - 488. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Topuzoglu, P. Ay, S. Hidiroglu, and Y. Gurbuz The barriers against childhood immunizations: a qualitative research among socio-economically disadvantaged mothers Eur J Public Health, August 1, 2007; 17(4): 348 - 352. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Rand, L. P. Shone, C. Albertin, P. Auinger, J. D. Klein, and P. G. Szilagyi National Health Care Visit Patterns of Adolescents: Implications for Delivery of New Adolescent Vaccines Arch Pediatr Adolesc Med, March 1, 2007; 161(3): 252 - 259. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Shaw, R. C. Wasserman, S. Barry, T. Delaney, P. Duncan, W. Davis, and P. Berry Statewide Quality Improvement Outreach Improves Preventive Services for Young Children Pediatrics, October 1, 2006; 118(4): e1039 - e1047. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Flanagan-Klygis, L. Sharp, and J. E. Frader Dismissing the Family Who Refuses Vaccines: A Study of Pediatrician Attitudes Arch Pediatr Adolesc Med, October 1, 2005; 159(10): 929 - 934. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Colgrove and R. Bayer Could It Happen Here? Vaccine Risk Controversies And The Specter Of Derailment Health Aff., May 1, 2005; 24(3): 729 - 739. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. V. Oster, C. A. McPhillips-Tangum, F. Averhoff, and K. Howell Barriers to Adolescent Immunization: A Survey of Family Physicians and Pediatricians J Am Board Fam Med, January 1, 2005; 18(1): 13 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C. Lee, J. A. Finkelstein, I. L. Miroshnik, D. Rusinak, J. M. Santoli, S. M. Lett, and T. A. Lieu Pediatricians' Self-reported Clinical Practices and Adherence to National Immunization Guidelines After the Introduction of Pneumococcal Conjugate Vaccine Arch Pediatr Adolesc Med, July 1, 2004; 158(7): 695 - 701. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. T. Luman, M. M. McCauley, A. Shefer, and S. Y. Chu Maternal Characteristics Associated With Vaccination of Young Children Pediatrics, May 1, 2003; 111(5): 1215 - 1218. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Gaudino, M. P. deHart, A. Cheadle, D. P. Martin, D. L. Moore, S. J. Schwartz, and B. Schulman Childhood Immunization Registries: Gaps Between Knowledge and Action Among Family Practice Physicians and Pediatricians in Washington State, 1998 Arch Pediatr Adolesc Med, October 1, 2002; 156(10): 978 - 985. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Zimmerman, T. A. Mieczkowski, H. M. Mainzer, A. R. Medsger, M. Raymund, J. A. Ball, and I. K. Jewell Effect of the Vaccines for Children Program on Physician Referral of Children to Public Vaccine Clinics: A Pre-Post Comparison Pediatrics, August 1, 2001; 108(2): 297 - 304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Taylor, P. M. Darden, D. A. Brooks, J. W. Hendricks, A. E. Baker, A. B. Bocian, K. Rohder, and R. C. Wasserman Impact of the Change to Inactivated Poliovirus Vaccine on the Immunization Status of Young Children in the United States: A Study From Pediatric Research in Office Settings and the National Medical Association Pediatrics, June 1, 2001; 107 (6): e90 - e90. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Lieu, R. L. Davis, A. M. Capra, L. K. Mell, C. P. Quesenberry, K. E. Martin, A. Zavitkovsky, S. B. Black, H. R. Shinefield, R. S. Thompson, et al. Variation in Clinician Recommendations for Multiple Injections During Adoption of Inactivated Polio Vaccine Pediatrics, April 1, 2001; 107(4): e49 - e49. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. C. Davis, D. D. Fredrickson, C. L. Arnold, J. T. Cross, S. G. Humiston, K. W. Green, and J. A. Bocchini Jr Childhood Vaccine Risk/Benefit Communication in Private Practice Office Settings: A National Survey Pediatrics, February 1, 2001; 107(2): 17e - 17. [Abstract] [Full Text]
|
|
|
|
|
|
B. G. Gellin, E. W. Maibach, and E. K. Marcuse Do Parents Understand Immunizations? A National Telephone Survey Pediatrics, November 1, 2000; 106(5): 1097 - 1102. [Abstract] [Full Text]
|
|
|
|
|
|
P. M. Darden Assessing Immunization Rates: The Importance of Denominators Pediatrics, July 1, 2000; 106(1): 169 - 170. [Full Text]
|
|
|
|
|
|
S. M. Kahane, J. P. Watt, K. Newell, S. Kellam, S. Wight, N. J. Smith, A. Reingold, and R. Adler Immunization Levels and Risk Factors for Low Immunization Coverage Among Private Practices Pediatrics, June 1, 2000; 105(6): 73e - 73. [Abstract] [Full Text]
|
|
|
|
|
|
S. T. Melman, T. T. Nguyen, E. Ehrlich, M. Schorr, and R. D. Anbar Parental Compliance With Multiple Immunization Injections Arch Pediatr Adolesc Med, December 1, 1999; 153(12): 1289 - 1291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. L. Freed, S. J. Clark, D. E. Pathman, R. Schectman, and J. Serling Impact of North Carolina's Universal Vaccine Purchase Program by Children's Insurance Status Arch Pediatr Adolesc Med, July 1, 1999; 153(7): 748 - 754. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Rodewald, E. Maes, J. Stevenson, B. Lyons, S. Stokley, and P. Szilagyi Immunization Performance Measurement in a Changing Immunization Environment Pediatrics, April 1, 1999; 103(4): 889 - 897. [Abstract] [Full Text]
|
|
|
|
|
|
R. C. Wasserman, E. J. Slora, A. B. Bocian, G. V. Fleming, A. E. Baker, S. E. Pedlow, and W. Kessel Pediatric Research in Office Settings (PROS): A National Practice-Based Research Network to Improve Children's Health Care Pediatrics, December 1, 1998; 102(6): 1350 - 1357. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Gadomski, J. Talarico, K. S. Abernethy, and H. G. Cicirello Population-Based Study of the Adequacy of Well-Child Care Services: A Rural County's Report Card Arch Pediatr Adolesc Med, August 1, 1998; 152(8): 745 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. K. Ball, G. Evans, and A. Bostrom Risky Business: Challenges in Vaccine Risk Communication Pediatrics, March 1, 1998; 101(3): 453 - 458. [Full Text] [PDF]
|
|
|
|
|
|
R. K. Zimmerman, J. J. Schlesselman, T. A. Mieczkowski, A. R. Medsger, and M. Raymund Physician Concerns About Vaccine Adverse Effects and Potential Litigation Arch Pediatr Adolesc Med, January 1, 1998; 152(1): 12 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Zimmerman, A. R. Medsger, E. M. Ricci, M. Raymund, T. A. Mieczkowski, and S. Grufferman Impact of Free Vaccine and Insurance Status on Physician Referral of Children to Public Vaccine Clinics JAMA, September 24, 1997; 278(12): 996 - 1000. [Abstract] [PDF]
|
|
|
|
|
|
R. K. Zimmerman, W. H. Barker, R. A. Strikas, E. R. Ahwesh, T. A. Mieczkowski, J. E. Janosky, and S. L. Kanter Developing Curricula to Promote Preventive Medicine Skills: The Teaching Immunization for Medical Education (TIME) Project JAMA, September 3, 1997; 278(9): 705 - 711. [Abstract] [PDF]
|
|
|
|
|
|
M. Genel Lessons From Practice-based Clinical Research Pediatrics, April 1, 1997; 99(4): 597 - 598. [Full Text] [PDF]
|
|
