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Peter G. Szilagyi, MD, MPH; Klaus J. Roghmann, PhD; James R. Campbell, MD; Sharon G. Humiston, MD, MPH; Nancy L. Winter, MPA; Richard F. Raubertas, PhD; Lance E. Rodewald, MD

Arch Pediatr Adolesc Med. 1994;148(2):158-166.

Abstract
Objectives
To assess variations in immunization practices and attitudes among primary care providers and to relate these characteristics to the immunization levels of their patients.

Setting
Monroe County, New York.

Design
Survey of pediatricians (n=96) and family practitioners (n=44) to assess immunization practices and attitudes and medical chart reviews for 1884 patients of 32 physicians who practice in the city of Rochester to measure immunization levels.

Analysis
Tabular analyses for survey responses (² test and Fisher's Exact Test); logistic regression to assess the relation between provider responses and measured immunization levels.

Results
Responses by pediatricians and family practitioners were similar. Most providers did not routinely immunize during acute-illness visits but did immunize during follow-up or chronic-illness visits. Few used tracking systems to identify underimmunized children. Most practitioners immunized children who had colds but withheld immunizations from children who had fevers or otitis media. Most providers agreed with expanding immunization programs to include sick visits, health department clinic visits, and community site visits, but most thought that they should not be provided at emergency department visits, except for very–high-risk children. Immunization levels at 10 months of age were positively correlated with private practice setting (P=.001) but negatively correlated with immunizing at acute- (P<.01) or chronic-illness (P<.05) visits, Medicaid coverage (P<.05), and high rates of appointments that were not kept (P<.001).

Conclusions
Primary care providers' immunization practices and attitudes vary and do not always follow established guidelines for immunization delivery. Many providers of high-risk children are already attempting to improve immunization delivery by using patient reminders and by immunizing children at acute- or chronic-illness visits. Improving provider immunization practices to deliver childhood immunizations more effectively must be part of our efforts to resolve this nation's childhood immunization problem.

(Arch Pediatr Adolesc Med. 1994;148:158-166)

Author Affiliations
From the Department of Pediatrics, Division of General Pediatrics (Drs Szilagyi, Roghmann, Campbell, Humiston, and Rodewald and Ms Winter), the Departments of Emergency Medicine (Drs Humiston and Rodewald), and Biostatistics (Dr Raubertas), University of Rochester (NY) School of Medicine and Dentistry.

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