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Adolescent Immunization Practices
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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