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Donna M. Kraus, PharmD; Margaret M. Campbell, PharmD; John F. Marcinak, MD

Arch Pediatr Adolesc Med. 1994;148(9):936-942.

Abstract
Objective
To characterize universal hepatitis B immunization practices of pediatricians who routinely provide childhood immunizations in Illinois.

Design
Survey of 522 randomly chosen Illinois pediatricians. Student's t test, X² analysis, and multi-variate logistic regression were used to identify relationships between physician demographics and outcomes of interest.

Main Outcome Measures
Physician agreement with the new Centers for Disease Control and Prevention Immunization Practices Advisory Committee and the American Academy of Pediatrics universal infant hepatitis B immunization guidelines, incorporation of the recommendations, routine hepatitis B immunization of older children (aged 6 months to 11 years), and routine hepatitis B immunization of adolescents.

Results
The survey response rate was 71.5%. Of those pediatricians routinely providing immunizations (N=323), 72.8% agreed with and 90.1% have incorporated universal hepatitis B immunization; 36.5% and 53.0% routinely immunized older children and adolescents, respectively. Pediatricians practicing in medium-sized practices were half as likely to agree with the recommendations (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.31 to 0.84). Cost and a belief that universal immunization of infants is not medically necessary were the two most commonly listed reasons for not incorporating the new guidelines. Percent reimbursement from public aid was negatively related to the routine immunization of older children (OR, 0.34; 95% CI, 0.12 to 0.95). Both percent reimbursement from self-pay (OR, 5.62; 95% CI, 2.25 to 14.05) and a rural location (OR, 0.16; 95% CI, 0.04 to 0.56) were related to routine hepatitis B immunization of adolescents. Gender and number of years in practice were not associated with physician response.

Conclusions
The majority of Illinois pediatricians who routinely provide pediatric immunizations have incorporated the new universal hepatitis B immunization guidelines into their practices. Continued efforts to address financial barriers and to educate physicians may hasten the time when the transmission of the hepatitis B virus will no longer occur.

(Arch Pediatr Adolesc Med. 1994;148:936-942)

Author Affiliations
From the Departments of Pharmacy Practice (Drs Kraus and Campbell) and Pediatrics (Drs Kraus and Marcinak) and the Division of Infectious Diseases (Dr Marcinak), University of Illinois at Chicago.

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