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  Vol. 149 No. 10, October 1995 TABLE OF CONTENTS
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A 'Barrier-Free' Health Care System Does Not Ensure Adequate Vaccination of 2-Year-Old Children

Coleen Baird Weese, MD, MPH; Margot R. Krauss, MD, MPH

Arch Pediatr Adolesc Med. 1995;149(10):1130-1135.


Abstract



Objectives
To assess vaccination status in a cohort of 2 year olds with access to health care at no cost and to delineate factors associated with failure to be fully vaccinated.

Design
Retrospective cross-sectional study. Children not up-to-date on vaccinations by age 2 years compared with children up-to-date by medical record review. A telephone survey was conducted for those without medical records or whose records lacked complete documentation.

Setting
Large military tertiary care hospital.

Participants
A cohort of 844 children born between August 31, 1988, and September 1, 1989.

Main Outcome Measures
Timeliness of vaccination, factors associated with undervaccination, number and nature of missed opportunities.

Results
Best estimate of coverage with entire primary vaccination series was 72% by age 2 years. Attendance at military day care was associated with full vaccination (odds ratio [OR]=1.80, confidence interval [CI] =1.12 to 3.24) as was completion of well-baby visits. Increasing number of other visits did not predict full vaccination. Children followed up by family practice were more likely to be up-to-date than children followed up by pediatrics (OR=3.67, CI=1.47 to 9.73). Seventy-two percent of children who were not up-to-date had at least one missed opportunity for vaccination. If vaccinations had been offered at all visits, 93% of children could have been fully vaccinated by age 2 years.

Conclusions
Offering free vaccinations in a "barrierfree" system will not ensure vaccination levels of 90%. Health care providers should offer vaccinations during acute, non-well visits to improve coverage.

(Arch Pediatr Adolesc Med. 1995;149:1130-1135)



Author Affiliations



From the Preventive Medicine Service, Madigan Army Medical Center, Tacoma, Wash. Dr Weese is now with the Disease Control and Prevention Division, US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, Md.



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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Strategies to Sustain Success in Childhood Immunizations
The National Vaccine Advisory Committee
JAMA 1999;282:363-370.
ABSTRACT | FULL TEXT  

Characteristics of Families Who Attend Free Vaccine Fairs
Hambidge et al.
Pediatrics 1999;104:158-163.
ABSTRACT | FULL TEXT  

Impact of Community Volunteers on Immunization Rates of Children Younger Than 2 Years
Barnes et al.
Arch Pediatr Adolesc Med 1999;153:518-524.
ABSTRACT | FULL TEXT  

Pattern of Prenatal Care and Infant Immunization Status in a Comprehensive Adolescent-Oriented Maternity Program
Stevens-Simon et al.
Arch Pediatr Adolesc Med 1996;150:829-833.
ABSTRACT  





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