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Pediatricians' Self-reported Clinical Practices and Adherence to National Immunization Guidelines After the Introduction of Pneumococcal Conjugate Vaccine
Karen C. Lee, MD;
Jonathan A. Finkelstein, MD, MPH;
Irina L. Miroshnik, MS;
Donna Rusinak, BS;
Jeanne M. Santoli, MD, MPH;
Susan M. Lett, MD, MPH;
Tracy A. Lieu, MD, MPH
Arch Pediatr Adolesc Med. 2004;158:695-701.
Background Little is known about whether pneumococcal conjugate vaccine (PCV) has altered pediatricians' practices regarding well-child and acute care.
Objectives To (1) describe whether PCV caused pediatricians to move other routine infant vaccines and/or add routine visits; (2) characterize adherence to national immunization recommendations; and (3) determine whether PCV altered pediatricians' planned clinical approach to well-appearing febrile infants.
Design and Methods One year after PCV was added to the pediatric immunization schedule, we mailed a 23-item survey to 691 randomly selected pediatricians in Massachusetts. The adjusted response rate was 77%.
Results After PCV introduction, 39% of pediatricians moved other routine infant vaccines to different visits and 15% added routine visits to the infant schedule. The self-reported immunization schedules of 36% were nonadherent to national immunization guidelines for at least 1 vaccine. Nonadherence rates were significantly higher among pediatricians who had been in practice longer, moved another vaccine because of PCV introduction, and/or offered to give shots later when multiple injections were due. For a hypothetical febrile 8-month-old girl who had received 3 doses of PCV, pediatricians reported they were significantly less likely to (1) perform both blood and urine testing and (2) prescribe antibiotics than in the pre-PCV era.
Conclusions The introduction of PCV may have had unintended effects on pediatric primary care, including decreased adherence to national recommendations for the timing of immunizations and decreased urine testing for well-appearing febrile infants. Special efforts may be warranted to ensure that pediatricians remain current with changing recommendations.
From the Harvard Pediatric Health Services Research Fellowship, Boston, Mass (Drs Lee, Finkelstein, and Lieu); the Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston (Dr Lee); the Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, (Drs Finkelstein, Miroshnik, and Lieu, Ms Rusinak); the Division of General Pediatrics, Children's Hospital Boston, Boston (Drs Finkelstein and Lieu); the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Santoli); and the Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Boston (Dr Lett). Dr Lee is now with the Epidemiology Branch, Division of Viral Hepatitis, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta.
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