Missed opportunities in preventive pediatric health care. Immunizations or well-child care visits?
J. Brown, P. Melinkovich, B. Gitterman and S. Ricketts
Department of Community Health Services, Denver Health and Hospitals.
OBJECTIVE--To determine the percentage of patients in a large pediatric
practice in compliance with national recommendations regarding
immunizations and well-child care visits. RESEARCH DESIGN--Chart review.
Point estimates with 95% confidence intervals were determined for reviewed
charts in compliance with recommendations of the Advisory Committee on
Immunization Practices (ACIP) of the Centers for Disease Control and
Prevention and schedule of well-child care visits, screening, and
anticipatory guidance recommended by the American Academy of Pediatrics
(AAP). SETTING--A large, multisite urban public pediatric practice.
PATIENTS--Three hundred eighty-six infants and children (aged 0 to 60
months) who had a total of 7595 patient visits. SELECTION PROCEDURE--A
random sample of charts. RESULTS--There was a large discrepancy in
compliance for patients aged 0 to 23 months in ACIP-recommended
immunizations (90.5% +/- 3.9%) vs AAP-recommended well-child care visits
(37.6% +/- 6.4%) and for patients aged 24 to 60 months in ACIP-recommended
immunizations (87.8% +/- 5.1%) vs AAP-recommended well-child care visits
(31.0% +/- 7.1%). CONCLUSIONS--The data suggest that immunization alone
does not ensure that children will receive all aspects of preventive care,
raising questions about the practicality of the current AAP recommendations
for preventive pediatric health care.
