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A National Survey of US Physicians

Stanley J. Schaffer, MD, MS; Sharon G. Humiston, MD, MPH; Laura Pollard Shone, MSW; Francisco M. Averhoff, MD, MPH; Peter G. Szilagyi, MD, MPH

Arch Pediatr Adolesc Med. 2001;155:566-571.

Background  Adolescent immunization rates remain low. Hence, a better understanding of the factors that influence adolescent immunization is needed.

Objective  To assess the adolescent immunization practices of US physicians.

Design and Setting  A 24-item survey mailed in 1997 to a national sample of 1480 pediatricians and family physicians living in the United States, randomly selected from the American Medical Association's Master List of Physicians.

Participants  Of 1110 physicians (75%) who responded, 761 met inclusion criteria.

Outcome Measures  Immunization practices and policies, use of tracking and recall, opinions about school-based immunizations, and reasons for not providing particular immunizations to eligible adolescents.

Results  Seventy-nine percent of physicians reported using protocols for adolescent immunization, and 82% recommended hepatitis B immunization for all eligible adolescents. Those who did not routinely immunize adolescents often cited insufficient insurance coverage for immunizations. While 42% of physicians reported that they review the immunization status of adolescent patients at acute illness visits, only 24% immunized eligible adolescents during such visits. Twenty-one percent used immunization tracking and recall systems. Though 84% preferred that immunizations be administered at their practice, 71% of physicians considered schools, and 63% considered teen clinics to be acceptable alternative adolescent immunization sites. However, many had concerns about continuity of care for adolescents receiving immunizations in school.

Conclusions  Most physicians supported adolescent immunization efforts. Barriers preventing adolescent immunization included financial barriers, record scattering, lack of tracking and recall, and missed opportunities. School-based immunization programs were acceptable to most physicians, despite concerns about continuity of care. Further research is needed to determine whether interventions that have successfully increased infant immunization rates are also effective for adolescents.

From the Departments of Pediatrics (Dr Schaffer, Ms Shone, and Dr Szilagyi) and Emergency Medicine (Dr Humiston), University of Rochester School of Medicine and Dentistry, Rochester, NY; and the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Averhoff).

Corresponding author: Stanley J. Schaffer, MD, Division of General Pediatrics, Box 777, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 (e-mail: Stanley_Schaffer{at}urmc.rochester.edu).

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