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Karen G Oconnor - One of the best experts on this subject based on the ideXlab platform.
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do on site mental health professionals change Pediatricians responses to children s mental health problems
Academic Pediatrics, 2016Co-Authors: Sarah M Horwitz, Karen G Oconnor, Andrew S. Garner, Amy Storferisser, Bonnie D Kerker, Moira Szilagyi, Kimberly Hoagwood, Cori Green, Jane Meschan FoyAbstract:Abstract Objective To assess the availability of on-site mental health professionals (MHPs) in primary care; to examine practice/Pediatrician characteristics associated with on-site MHPs; and to determine whether the presence of on-site MHPs is related to Pediatricians' comanaging or more frequently identifying, treating/managing, or referring mental health (MH) problems. Methods Analyses included American Academy of Pediatrics (AAP) members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (n = 321). Measures included sociodemographics, practice characteristics, questions about on-site MHPs, comanagement of MH problems, and Pediatricians' behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate, and multivariable analyses were performed. Results Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools, universities, health maintenance organizations, Conclusions On-site MHPs are more frequent in settings where low-income children are served and where Pediatricians train. Pediatricians who comanage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, substance abuse counselor, or social worker. Overall, on-site MHPs were not associated with comanagement or increased likelihood of Pediatricians identifying, treating/managing, or referring children with 5 common child MH problems.
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vaccine delays refusals and patient dismissals a survey of Pediatricians
Pediatrics, 2016Co-Authors: Catherine Houghtelford, David W Kimberlin, Inmaculada Aban, William P Hitchcock, Jon R Almquist, Richard Kratz, Karen G OconnorAbstract:BACKGROUND: Parental noncompliance with the American Academy of Pediatrics and Centers for Disease Control and Prevention immunization schedule is an increasing public health concern. We examined the frequency of requests for vaccine delays and refusals and the impact on US Pediatricians’ behavior. METHODS: Using national American Academy of Pediatrics Periodic Surveys from 2006 and 2013, we describe Pediatrician perceptions of prevalence of (1) vaccine refusals and delays, (2) parental reasons for refusals and/or delays, and (3) physician dismissals. Questions about vaccine delays were asked only in 2013. We examined the frequency, reasons for, and management of both vaccine refusals and delays by using bivariate and multivariable analyses, which were controlled for practice characteristics, demographics, and survey year. RESULTS: The proportion of Pediatricians reporting parental vaccine refusals increased from 74.5% in 2006 to 87.0% in 2013 ( P P = .002). A total of 75.0% of Pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of Pediatricians reported “always” dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% ( P = .004). CONCLUSIONS: Pediatricians reported increased vaccine refusal between 2006 and 2013. They perceive that vaccine-refusing parents increasingly believe that immunizations are unnecessary. Pediatricians continue to provide vaccine education but are also dismissing patients at higher rates.
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changes in language services use by us Pediatricians
Pediatrics, 2013Co-Authors: Lisa Ross Decamp, Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:BACKGROUND AND OBJECTIVES: Access to appropriate language services is critical for ensuring patient safety and reducing the impact of language barriers. This study compared language services use by US Pediatricians in 2004 and 2010 and examined variation in use in 2010 by Pediatrician, practice, and state characteristics. METHODS: We used data from 2 national surveys of Pediatricians (2004: n = 698; 2010: n = 683). Analysis was limited to postresidency Pediatricians with patients with limited English proficiency (LEP). Pediatricians reported use of ≥1 communication methods with LEP patients: bilingual family member, staff, physician, formal interpreter (professional, telephone), and primary-language written materials. Bivariate analyses examined 2004 to 2010 changes in methods used, and 2010 use by characteristics of Pediatricians (age, sex, ethnicity), practices (type, location, patient demographics), and states (LEP population, Latino population growth, Medicaid/Children’s Health Insurance Program language services reimbursement). Multivariate logistic regression was performed to determine adjusted odds of use of each method. RESULTS: Most Pediatricians reported using family members to communicate with LEP patients and families, but there was a decrease from 2004 to 2010 (69.6%, 57.1%, P < .01). A higher percentage of Pediatricians reported formal interpreter use (professional and/or telephone) in 2010 (55.8%) than in 2004 (49.7%, P < .05); the increase was primarily attributable to increased telephone interpreter use (28.2%, 37.8%, P < .01). Pediatricians in states with reimbursement had twice the odds of formal interpreter use versus those in nonreimbursing states (odds ratio 2.34; 95% confidence interval 1.24–4.40). CONCLUSIONS: US Pediatricians’ use of appropriate language services has only modestly improved since 2004. Expanding language services reimbursement may increase formal interpreter use. * Abbreviations: AAP — : American Academy of Pediatrics CHIP — : Children’s Health Insurance Program CLAS standards — : National Standards for Culturally and Linguistically Appropriate Services LEP — : limited English proficiency
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adoption of body mass index guidelines for screening and counseling in pediatric practice
Pediatrics, 2010Co-Authors: Jonathan D Klein, Karen G Oconnor, Stephen Cook, Tracy S Sesselberg, Mark S Johnson, Marian Coon, Charles J Homer, Nancy F Krebs, Reginald WashingtonAbstract:OBJECTIVE: The purpose of this study was to examine Pediatrician implementation of BMI and provider interventions for childhood overweight prevention and treatment. METHODS: Data were obtained from the American Academy of Pediatrics (AAP) Periodic Survey of Fellows No. 65, a nationally representative survey of AAP members. Surveys that addressed the provision of screening and management of childhood overweight and obesity in primary care settings were mailed to 1622 nonretired US AAP members in 2006. RESULTS: One thousand five (62%) surveys were returned; 677 primary care clinicians in active practice were eligible for the survey. Nearly all respondents (99%) reported measuring height and weight at well visits, and 97% visually assess children for overweight at most or every well-child visit. Half of the respondents (52%) assess BMI percentile for children older than 2 years. Most Pediatricians reported that they do not have time to counsel on overweight and obesity, that counseling has poor results, and that having simple diet and exercise recommendations would be helpful in their practice. Pediatricians in large practices and those who had attended continuing medical education on obesity were more familiar with national expert guidelines, were more likely to use BMI percentile, and had higher self-efficacy in practices related to childhood and adolescent overweight and obesity. Multivariate analysis revealed that Pediatricians with better access to community and adjunct resources were more likely to use BMI percentile. CONCLUSIONS: BMI-percentile screening in primary pediatric practice is underused. Most Pediatricians believe that they can and should try to prevent overweight and obesity, yet few believe there are good treatments once a child is obese. Training, time, and resource limitations affect BMI-percentile use. Awareness of national guidelines may improve rates of BMI-percentile use and recognition of opportunities to prevent childhood and adolescent obesity.
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Pediatricians use of language services for families with limited english proficiency
Pediatrics, 2007Co-Authors: Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:OBJECTIVES. Patients with limited English proficiency confront multiple barriers to health care access in the United States. Appropriate language services for families with limited English proficiency are essential; however, little is known about Pediatricians9 use of language services. The objective of this study was to examine Pediatricians9 provision of language services to patients with limited English proficiency and the Pediatrician, practice, and state characteristics associated with use of these services. METHODS. Data were obtained from the Periodic Survey of Fellows No. 60, a nationally representative survey of members of the American Academy of Pediatrics. A total of 1829 surveys were mailed, and responses were obtained from 58%. Use of 6 language services was assessed. Factors associated with language services use were examined after adjusting for physician, practice, and state characteristics. RESULTS. Bilingual family members (70%) and bilingual staff (58%) were the most frequently reported language services; 40% of respondents report the use of professional interpreters, 28% use telephone interpreters, and 35% of practices report provision of translated written materials. Pediatricians in smaller and rural practices and in states with higher proportions of limited English proficiency persons report less use of professional interpreters. Pediatricians in states with third-party reimbursement for language services are more likely to report use of professional interpreters. CONCLUSIONS. Most Pediatricians report using untrained interpreters to communicate with limited English proficiency patients and their families. Pediatricians in regions with high proportions of limited English proficiency persons may be less likely to provide appropriate language services. Third-party reimbursement for professional language services may increase the use of trained interpreters and quality of care.
Cynthia S Minkovitz - One of the best experts on this subject based on the ideXlab platform.
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five year follow up of community pediatrics training initiative
Pediatrics, 2014Co-Authors: Cynthia S Minkovitz, Matt Goldshore, Barry S Solomon, Bernard Guyer, Holly GrasonAbstract:OBJECTIVE: To compare community involvement of Pediatricians exposed to enhanced residency training as part of the Dyson Community Pediatrics Training Initiative (CPTI) with involvement reported by a national sample of Pediatricians. METHODS: A cross-sectional analyses compared 2008–2010 mailed surveys of CPTI graduates 5 years after residency graduation with comparably aged respondents in a 2010 mailed national American Academy of Pediatrics survey of US Pediatricians (CPTI: n = 234, response = 56.0%; national sample: n = 243; response = 59.9%). Respondents reported demographic characteristics, practice characteristics (setting, time spent in general pediatrics), involvement in community child health activities in past 12 months, use of ≥1 strategies to influence community child health (eg, educate legislators), and being moderately/very versus not at all/minimally skilled in 6 such activities (eg, identify community needs). χ 2 statistics assessed differences between groups; logistic regression modeled the independent association of CPTI with community involvement adjusting for personal and practice characteristics and perspectives regarding involvement. Results: Compared with the national sample, more CPTI graduates reported involvement in community pediatrics (43.6% vs 31.1%, P P P > .05). Differences in involvement remained in adjusted analyses with greater involvement by CPTI graduates (adjusted odds ratio 2.4, 95% confidence interval 1.5–3.7). Conclusions: Five years after residency, compared with their peers, more CPTI graduates report having skills and greater community pediatrics involvement. Enhanced residency training in community pediatrics may lead to a more engaged Pediatrician workforce.
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changes in language services use by us Pediatricians
Pediatrics, 2013Co-Authors: Lisa Ross Decamp, Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:BACKGROUND AND OBJECTIVES: Access to appropriate language services is critical for ensuring patient safety and reducing the impact of language barriers. This study compared language services use by US Pediatricians in 2004 and 2010 and examined variation in use in 2010 by Pediatrician, practice, and state characteristics. METHODS: We used data from 2 national surveys of Pediatricians (2004: n = 698; 2010: n = 683). Analysis was limited to postresidency Pediatricians with patients with limited English proficiency (LEP). Pediatricians reported use of ≥1 communication methods with LEP patients: bilingual family member, staff, physician, formal interpreter (professional, telephone), and primary-language written materials. Bivariate analyses examined 2004 to 2010 changes in methods used, and 2010 use by characteristics of Pediatricians (age, sex, ethnicity), practices (type, location, patient demographics), and states (LEP population, Latino population growth, Medicaid/Children’s Health Insurance Program language services reimbursement). Multivariate logistic regression was performed to determine adjusted odds of use of each method. RESULTS: Most Pediatricians reported using family members to communicate with LEP patients and families, but there was a decrease from 2004 to 2010 (69.6%, 57.1%, P < .01). A higher percentage of Pediatricians reported formal interpreter use (professional and/or telephone) in 2010 (55.8%) than in 2004 (49.7%, P < .05); the increase was primarily attributable to increased telephone interpreter use (28.2%, 37.8%, P < .01). Pediatricians in states with reimbursement had twice the odds of formal interpreter use versus those in nonreimbursing states (odds ratio 2.34; 95% confidence interval 1.24–4.40). CONCLUSIONS: US Pediatricians’ use of appropriate language services has only modestly improved since 2004. Expanding language services reimbursement may increase formal interpreter use. * Abbreviations: AAP — : American Academy of Pediatrics CHIP — : Children’s Health Insurance Program CLAS standards — : National Standards for Culturally and Linguistically Appropriate Services LEP — : limited English proficiency
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Pediatricians use of language services for families with limited english proficiency
Pediatrics, 2007Co-Authors: Dennis Z Kuo, Karen G Oconnor, Glenn Flores, Cynthia S MinkovitzAbstract:OBJECTIVES. Patients with limited English proficiency confront multiple barriers to health care access in the United States. Appropriate language services for families with limited English proficiency are essential; however, little is known about Pediatricians9 use of language services. The objective of this study was to examine Pediatricians9 provision of language services to patients with limited English proficiency and the Pediatrician, practice, and state characteristics associated with use of these services. METHODS. Data were obtained from the Periodic Survey of Fellows No. 60, a nationally representative survey of members of the American Academy of Pediatrics. A total of 1829 surveys were mailed, and responses were obtained from 58%. Use of 6 language services was assessed. Factors associated with language services use were examined after adjusting for physician, practice, and state characteristics. RESULTS. Bilingual family members (70%) and bilingual staff (58%) were the most frequently reported language services; 40% of respondents report the use of professional interpreters, 28% use telephone interpreters, and 35% of practices report provision of translated written materials. Pediatricians in smaller and rural practices and in states with higher proportions of limited English proficiency persons report less use of professional interpreters. Pediatricians in states with third-party reimbursement for language services are more likely to report use of professional interpreters. CONCLUSIONS. Most Pediatricians report using untrained interpreters to communicate with limited English proficiency patients and their families. Pediatricians in regions with high proportions of limited English proficiency persons may be less likely to provide appropriate language services. Third-party reimbursement for professional language services may increase the use of trained interpreters and quality of care.
Larry J Baraff - One of the best experts on this subject based on the ideXlab platform.
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parental compliance with after hours telephone triage advice nurse advice service versus on call Pediatricians
Clinical Pediatrics, 2003Co-Authors: Thomas J Lee, Larry J Baraff, Judith Guzy, David W Johnson, Stephen P Wall, Heide WooAbstract:To compare parental compliance with after-hours triage advice provided by telephone advice nurses and on-call Pediatricians, a randomized controlled trial was undertaken at a university general pediatrics practice that enrolled parents or guardians calling for after-hours advice. Advice calls were randomized to a call center advice nurse or the on-call Pediatrician. Parental compliance with the triage advice and agreement of the parental report of advice with the Pediatrician/nurse report of advice given was evaluated. There were 566 participants in the Pediatrician and 616 in the nurse group. Compliance with advice (Pediatrician v. nurse) was not significantly different for emergent/urgent care (75.8% v. 72.6%) and self care (74.3% v. 77.2%) but was significantly higher in the Pediatrician group for office care (51.5% v. 29.6%; 95% CI of difference, 8.9%-34.2%). Overall agreement between the caller reported and physician or nurse advice was 84.5% for emergent/ urgent, 42.7% for office care, and 93.7% for self-care.
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does telephone triage delay significant medical treatment advice nurse service vs on call Pediatricians
JAMA Pediatrics, 2003Co-Authors: Thomas J Lee, Larry J Baraff, Judith Guzy, David W Johnson, Heide WooAbstract:Background Advice nurse call centers are used to ensure access to medical advice, thereby potentially reducing the costs of health services. Objective To determine if medical advice from advice nurses and on-call physicians delays significant medical treatment in a general pediatrics population. Design Randomized controlled trial. Setting A university general pediatrics faculty practice. Participants Parents or guardians calling for after-hours advice regarding their children. Intervention After-hours medical advice calls were randomized at the time of the call to an advice nurse or an on-call Pediatrician. Main Outcome Measures The proportion of callers who sought medical care not advised by the advice nurse or on-call Pediatrician and the proportion who received unadvised significant care. Results There were 1182 advice calls: 566 in the Pediatrician group and 616 in the advice nurse group. There were no significant differences in the types of telephone triage advice in the physician and advice nurse groups. There was no significant difference in the proportion of callers who sought unadvised care (108 [19.9%] in the physician group vs 110 [19.0%] in the advice nurse group) or in the proportion of callers who received unadvised significant care (23 [4.2%] in the physician group vs 25 [4.3%] in the advice nurse group). Conclusions The proportions of callers who sought unadvised medical care and who received unadvised significant care were not significantly different in the advice nurse and Pediatrician groups. This suggests that advice nurses do not delay significant medical treatment when compared with Pediatricians.
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caller satisfaction with after hours telephone advice nurse advice service versus on call Pediatricians
Pediatrics, 2002Co-Authors: Judith Guzy, David W Johnson, Larry J BaraffAbstract:OBJECTIVE: To compare caller satisfaction with after-hours medical advice provided by a for-profit nurse advice service with advice provided by on-call Pediatricians. METHODS: The study setting was the general pediatrics faculty practice of an urban university medical center. Participants were parents or guardians of a population of approximately 6000 children calling for after-hours medical advice over a 10-month period from January 18 to November 20, 2000. After-hours medical advice calls were randomized to either a nurse advice service or the on-call Pediatrician. Caller satisfaction and subsequent health care utilization were measured by a telephone survey of callers and review of all health care visits within 3 days of the initial telephone advice call. RESULTS: Five hundred sixty-six (48%) callers were enrolled in the on-call Pediatrician group, and 616 (52%) were enrolled in the advice nurse group. Caller satisfaction was rated as very good or excellent significantly more often for the on-call Pediatrician than for the nurse advice service as follows: telephone call overall (68.5% vs 55.0%; 95% confidence interval [CI] of difference: 8.0%-19.0%), thoroughness and competence of the person they spoke with (74.0% vs 59.1%; 95% CI of difference: 9.6%-20.2%), courtesy and friendliness of the person they spoke with (77.4% vs 73.9%; 95% CI of difference: -1.4%-8.4%), length of time spent waiting (70.8% vs 60.1%; 95% CI of difference: 5.4%-16.2%), time spent talking with the on-call Pediatrician or advice nurse (68.2% vs 52.4%; 95% CI of difference: 10.2%-21.3%), and the medical advice given (68.6% vs 53.9%; 95% CI of difference: 9.2%-20.1%). Compliance with the advice given was significantly higher for office care in the on-call Pediatrician group (51.5% vs 29.6%; 95% CI of difference: 8.9%-34.2%). Repeat calls for advice were significantly more frequent for the nurse advice service, both within 4 hours (13.0% vs 4.8%; 95% CI of difference: 5.0%-11.4%), and within 72 hours (23.4% vs 13.3%; 95% CI of difference: 5.8%-14.5%). CONCLUSION: Callers were less satisfied with medical advice provided by a nurse advice service compared with the traditional on-call Pediatrician. The lower satisfaction was associated with somewhat poorer compliance with recommended triage dispositions and more frequent repeat calls for medical advice.
Heide Woo - One of the best experts on this subject based on the ideXlab platform.
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Pediatrician interventions and thirdhand smoke beliefs of parents
American Journal of Preventive Medicine, 2012Co-Authors: Jeremy E Drehmer, Richard C Wasserman, Jonathan P Winickoff, Nancy A Rigotti, Heide Woo, Deborah J Ossip, Emara Nabiburza, Yuchiao ChangAbstract:Background Thirdhand smoke is residual tobacco smoke contamination that remains after a cigarette is extinguished. A national study indicates that adults' belief that thirdhand smoke (THS) harms children is associated with strict household no-smoking policies. The question of whether Pediatricians can influence THS beliefs has not been assessed. Purpose To identify prevalence of THS beliefs and associated factors among smoking parents, and the association of Pediatrician intervention on parent belief that THS is harmful to their children. Methods Exit interview data were collected from 1980 parents following a pediatric office visit. Parents' level of agreement or disagreement that THS can harm the health of babies and children was assessed. A multivariate logistic regression model was constructed to identify whether Pediatricians' actions were independently associated with parental belief that THS can harm the health of babies and children. Data were collected from 2009 to 2011, and analyses were conducted in 2012. Results Ninety-one percent of parents believed that THS can harm the health of babies and children. Fathers (AOR=0.59, 95% CI=0.42, 0.84) and parents who smoked more than ten cigarettes per day (AOR=0.63, 95% CI=0.45, 0.88) were less likely to agree with this statement. In contrast, parents who received advice (AOR=1.60, 95% CI=1.04, 2.45) to have a smokefree home or car or to quit smoking and parents who were referred (AOR=3.42, 95% CI=1.18, 9.94) to a “quitline” or other cessation program were more likely to agree that THS can be harmful. Conclusions Fathers and heavier smokers were less likely to believe that THS is harmful. However, Pediatricians' actions to encourage smoking parents to quit or adopt smokefree home or car policies were associated with parental beliefs that THS harms children. Trial registration This study is registered at NCT00664261 .
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parental compliance with after hours telephone triage advice nurse advice service versus on call Pediatricians
Clinical Pediatrics, 2003Co-Authors: Thomas J Lee, Larry J Baraff, Judith Guzy, David W Johnson, Stephen P Wall, Heide WooAbstract:To compare parental compliance with after-hours triage advice provided by telephone advice nurses and on-call Pediatricians, a randomized controlled trial was undertaken at a university general pediatrics practice that enrolled parents or guardians calling for after-hours advice. Advice calls were randomized to a call center advice nurse or the on-call Pediatrician. Parental compliance with the triage advice and agreement of the parental report of advice with the Pediatrician/nurse report of advice given was evaluated. There were 566 participants in the Pediatrician and 616 in the nurse group. Compliance with advice (Pediatrician v. nurse) was not significantly different for emergent/urgent care (75.8% v. 72.6%) and self care (74.3% v. 77.2%) but was significantly higher in the Pediatrician group for office care (51.5% v. 29.6%; 95% CI of difference, 8.9%-34.2%). Overall agreement between the caller reported and physician or nurse advice was 84.5% for emergent/ urgent, 42.7% for office care, and 93.7% for self-care.
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does telephone triage delay significant medical treatment advice nurse service vs on call Pediatricians
JAMA Pediatrics, 2003Co-Authors: Thomas J Lee, Larry J Baraff, Judith Guzy, David W Johnson, Heide WooAbstract:Background Advice nurse call centers are used to ensure access to medical advice, thereby potentially reducing the costs of health services. Objective To determine if medical advice from advice nurses and on-call physicians delays significant medical treatment in a general pediatrics population. Design Randomized controlled trial. Setting A university general pediatrics faculty practice. Participants Parents or guardians calling for after-hours advice regarding their children. Intervention After-hours medical advice calls were randomized at the time of the call to an advice nurse or an on-call Pediatrician. Main Outcome Measures The proportion of callers who sought medical care not advised by the advice nurse or on-call Pediatrician and the proportion who received unadvised significant care. Results There were 1182 advice calls: 566 in the Pediatrician group and 616 in the advice nurse group. There were no significant differences in the types of telephone triage advice in the physician and advice nurse groups. There was no significant difference in the proportion of callers who sought unadvised care (108 [19.9%] in the physician group vs 110 [19.0%] in the advice nurse group) or in the proportion of callers who received unadvised significant care (23 [4.2%] in the physician group vs 25 [4.3%] in the advice nurse group). Conclusions The proportions of callers who sought unadvised medical care and who received unadvised significant care were not significantly different in the advice nurse and Pediatrician groups. This suggests that advice nurses do not delay significant medical treatment when compared with Pediatricians.
Richard L Wasserman - One of the best experts on this subject based on the ideXlab platform.
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the influence of provider behavior parental characteristics and a public policy initiative on the immunization status of children followed by private Pediatricians a study from pediatric research in office settings
Pediatrics, 1997Co-Authors: James A Taylor, Eric J Slora, Paul M Darden, Cynthia M Hasemeier, Linda Asmussen, Richard L WassermanAbstract:Objectives. To determine the relative impact of parental characteristics, provider behavior, and the provision of free vaccines through state-sponsored vaccine volume programs (VVPs) on the immunization status of children followed by private Pediatricians. Study Design. Retrospective and cross-sectional surveys of immunization data. Setting. The offices of 15 private Pediatricians, from 11 states, who were members of the Pediatric Research in Office Settings network. Seven of these physicians used vaccines provided through VVPs. Patients. Children 2 to 3 years old followed by the participating physicians. Methods. The immunization status of children was assessed from two separate samples. For sample 1, immunization data were abstracted from the medical records of 60 consecutive eligible children seen in each office. Parents of the selected children indicated the method of payment for immunizations and the education levels of the mothers. Because this cross-sectional survey might have oversampled frequent health care users, a retrospective chart review of up to 75 randomly selected children in each Pediatrician's practice was also conducted (sample 2). Additional data were collected from the parents of children in sample 2 by telephone interviews. For both samples, patients were considered to be fully immunized if they had received four diphtheria-tetanus-pertussis/diphtheria-tetanus vaccines, three oral poliovirus/inactivated poliovirus vaccines, and one mea-sles-mumps-rubella vaccine before their second birthdays. Before collecting vaccination data, Pediatricians completed a survey detailing their immunization beliefs and practices. Logistic regression was used to identify factors that were independently associated with a child being fully immunized. Results. For sample 1, 81.7% of the 857 children surveyed were fully immunized. Practitioner-specific immunization rates varied widely, ranging from 51% to 97%. The immunization rate of children who received vaccines provided by VVPs was similar to that of children whose immunizations were not provided by VVPs (81.2% vs 82.2%; odds ratio [OR] for a VVP as a predictor for being fully immunized, 0.94, 95% confidence interval [CI], 0.66 to 1.32). In addition, parents who paid for immunizations out of pocket were as likely to have fully immunized children as those who had little or no out-of-pocket expenditures for vaccines (OR, 1.13; 95% CI, 0.75 to 1.13). In the logistic model, only individual Pediatrician and size of the metropolitan area in which the Pediatrician's practice was located were significant predictors of a child's immunization status. The results from sample 2 were similar; 82.1% of the 772 surveyed patients were fully immunized. With sample 2, individual Pediatrician and age of the child at the time of the survey were the only predictors of immunization status. The OR of a VVP as a predictor of a child being fully immunized was 1.37 (95% CI, 0.65 to 2.90). Conclusions. Individual provider behavior may be the most important determinant of the immunization status of children followed by private Pediatricians. In our samples, the effect of parental characteristics was limited. State-sponsored VVPs were not associated with higher immunization rates, perhaps because cost of vaccines did not seem to be a significant barrier to immunization in this population. Pediatrics 1997;99:209-215; immunization, private Pediatricians, provider behavior, vaccination.
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the influence of provider behavior parental characteristics and a public policy initiative on the immunization status of children followed by private Pediatricians a study from pediatric research in office settings
Pediatrics, 1997Co-Authors: James A Taylor, Eric J Slora, Paul M Darden, Cynthia M Hasemeier, Linda Asmussen, Richard L WassermanAbstract:Objectives. To determine the relative impact of parental characteristics, provider behavior, and the provision of free vaccines through state-sponsored vaccine volume programs (VVPs) on the immunization status of children followed by private Pediatricians. Study Design. Retrospective and cross-sectional surveys of immunization data. Setting. The offices of 15 private Pediatricians, from 11 states, who were members of the Pediatric Research in Office Settings network. Seven of these physicians used vaccines provided through VVPs. Patients. Children 2 to 3 years old followed by the participating physicians. Methods. The immunization status of children was assessed from two separate samples. For sample 1, immunization data were abstracted from the medical records of 60 consecutive eligible children seen in each office. Parents of the selected children indicated the method of payment for immunizations and the education levels of the mothers. Because this cross-sectional survey might have oversampled frequent health care users, a retrospective chart review of up to 75 randomly selected children in each Pediatrician9s practice was also conducted (sample 2). Additional data were collected from the parents of children in sample 2 by telephone interviews. For both samples, patients were considered to be fully immunized if they had received four diphtheria-tetanus-pertussis/diphtheria-tetanus vaccines, three oral poliovirus/inactivated poliovirus vaccines, and one measles-mumps-rubella vaccine before their second birthdays. Before collecting vaccination data, Pediatricians completed a survey detailing their immunization beliefs and practices. Logistic regression was used to identify factors that were independently associated with a child being fully immunized. Results. For sample 1, 81.7% of the 857 children surveyed were fully immunized. Practitioner-specific immunization rates varied widely, ranging from 51% to 97%. The immunization rate of children who received vaccines provided by VVPs was similar to that of children whose immunizations were not provided by VVPs (81.2% vs 82.2%; odds ratio [OR] for a VVP as a predictor for being fully immunized, 0.94, 95% confidence interval [CI], 0.66 to 1.32). In addition, parents who paid for immunizations out of pocket were as likely to have fully immunized children as those who had little or no out-of-pocket expenditures for vaccines (OR, 1.13; 95% CI, 0.75 to 1.13). In the logistic model, only individual Pediatrician and size of the metropolitan area in which the Pediatrician9s practice was located were significant predictors of a child9s immunization status. The results from sample 2 were similar; 82.1% of the 772 surveyed patients were fully immunized. With sample 2, individual Pediatrician and age of the child at the time of the survey were the only predictors of immunization status. The OR of a VVP as a predictor of a child being fully immunized was 1.37 (95% CI, 0.65 to 2.90). Conclusions. Individual provider behavior may be the most important determinant of the immunization status of children followed by private Pediatricians. In our samples, the effect of parental characteristics was limited. State-sponsored VVPs were not associated with higher immunization rates, perhaps because cost of vaccines did not seem to be a significant barrier to immunization in this population.
