This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Richard Kent Zimmerman, MD, MPH; James J. Schlesselman, PhD; Allison L. Baird; Tammy A. Mieczkowski, MA

Arch Pediatr Adolesc Med. 1997;151(7):657-664.

Abstract
Objective
To determine the causes of low childhood immunization rates based on physicians' knowledge, attitudes, and self-reported practices concerning childhood immunization.

Design
A standardized telephone survey conducted by trained interviewers.

Setting
Primary care physicians across the United States.

Participants
A stratified random sample of office-based family physicians, pediatricians, and general practitioners younger than 65 years was selected from the American Medical Association master file list that includes nonmembers. Physicians seeing 5 or more patients per week younger than 6 years and having 50% or more primary care patients were eligible for study. Of 1769 eligible physicians who spoke directly with the interviewers, 70% (N=1241) completed the questionnaire.

Interventions
The interview was designed to determine physicians' likelihood of recommending vaccinaPhD; Allison L. Baird; Tammy A. Mieczkowski, MA tion in common clinical scenarios and to probe reasons behind these decisions.

Results
Only 4% of physicians who thought the risk for side effects was increased by upper respiratory tract infection (URI) were likely to vaccinate a child with URI vs 55% of physicians who thought there would be no increased risk (P<.001). Eighty-three percent of those who thought the efficacy of measles, mumps, and rubella vaccine would not be affected by a URI recommended vaccination vs only 8% of physicians who thought efficacy would decrease (P<.001). Some respondents (11%) would not administer 3 injectable vaccines simultaneously based on beliefs about side effects, parental objections, and vaccine efficacy. Physicians' likelihood of vaccination also varied by type of visit: 47% were less likely to vaccinate a child with a URI in an acute care as opposed to a well-child setting.

Conclusion
Physicians' beliefs and practice policies materially influence their likelihood of recommending vaccinations.

Arch Pediatr Adolesc Med. 1997;151:657-664

Author Affiliations
From the Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Behavioral Approaches to Anxiety and Pain Management for Pediatric Venous Access
Cohen
Pediatrics 2008;122:S134-S139.
ABSTRACT | FULL TEXT  

How Do Physicians Immunize Their Own Children? Differences Among Pediatricians and Nonpediatricians
Posfay-Barbe et al.
Pediatrics 2005;116:e623-e633.
ABSTRACT | FULL TEXT  

Clinician Satisfaction with Vaccination Visits and the Role of Multiple Injections, Results from the Covise Study (Combination Vaccines Impact on Satisfaction and Epidemiology)
Meyerhoff et al.
CLIN PEDIATR 2004;43:87-93.
ABSTRACT  

The Effect of Education, Feedback, and Provider Prompts on the Rate of Missed Vaccine Opportunities in a Community Health Center
Sabnis et al.
CLIN PEDIATR 2003;42:147-151.
ABSTRACT  

Paediatricians' misconceptions on childhood immunisations
Stathopulu
Arch. Dis. Child. 2002;87:264-264.
FULL TEXT  

Adolescent Immunization Practices: A National Survey of US Physicians
Schaffer et al.
Arch Pediatr Adolesc Med 2001;155:566-571.
ABSTRACT | FULL TEXT  

Variation in Clinician Recommendations for Multiple Injections During Adoption of Inactivated Polio Vaccine
Lieu et al.
Pediatrics 2001;107:e49-e49.
ABSTRACT | FULL TEXT  

Childhood Vaccine Risk/Benefit Communication in Private Practice Office Settings: A National Survey
Davis et al.
Pediatrics 2001;107:17e-17.
ABSTRACT | FULL TEXT  

Estimation of Neonatal Outcome and Perinatal Therapy Use
Morse et al.
Pediatrics 2000;105:1046-1050.
ABSTRACT | FULL TEXT  

Parental Compliance With Multiple Immunization Injections
Melman et al.
Arch Pediatr Adolesc Med 1999;153:1289-1291.
ABSTRACT | FULL TEXT  

A Statewide Survey of General Practitioners in NSW, Australia, about Immunisation and Strategies to Increase Childhood Immunisation Rates
Guevarra et al.
Asia Pac J Public Health 1999;11:20-25.
ABSTRACT  

Immunization Survey in Iowa
Golombek et al.
Arch Pediatr Adolesc Med 1998;152:208-209.
FULL TEXT  

Physician Concerns About Vaccine Adverse Effects and Potential Litigation
Zimmerman et al.
Arch Pediatr Adolesc Med 1998;152:12-19.
ABSTRACT | FULL TEXT  

Vapocoolant Spray Is Equally Effective as EMLA Cream in Reducing Immunization Pain in School-aged Children
Cohen Reis and Holubkov
Pediatrics 1997;100:e5-e5.
ABSTRACT | FULL TEXT  

Impact of Free Vaccine and Insurance Status on Physician Referral of Children to Public Vaccine Clinics
Zimmerman et al.
JAMA 1997;278:996-1000.
ABSTRACT  

Developing Curricula to Promote Preventive Medicine Skills: The Teaching Immunization for Medical Education (TIME) Project
Zimmerman et al.
JAMA 1997;278:705-711.
ABSTRACT