Practitioner policies and beliefs and practice immunization rates: A study from pediatric research in office settings and the National Medical Association

Objective. To identify vaccination policies and beliefs associated with practice immunization rates (PIR) among office-based pediatricians. Methods. Primary care pediatricians recruited from the Pediatric Research in Office Settings (PROS) network of the American Academy of Pediatrics or the Pediatric Section of the National Medical Association abstracted immunization data from a consecutive sample of children who were 8 to 35 months old and seen in the office for any reason; 1 provider per practice collected this information. PIR were determined at 8 and 19 months of age by calculating the percentage of children in the sample who were fully immunized at that age. Before collecting the immunization data, all practitioners in each participating practice completed a questionnaire detailing his or her policies and beliefs regarding the administration of vaccines. Part of the questionnaire was a scenario involving a 4-month-old child who was due for a diphtheria-tetanus-acellular pertussis immunization at a health supervision visit. A list of 13 possible clinical conditions in this hypothetical patient were presented; practitioners were asked which of these were a contra-indication to vaccination. One set of policies and beliefs was computed for each practice using a weighted average of the responses of each provider in a particular practice. Regression analyses were used to assess the association between each policy and belief and PIR at 8 and 19 months, after controlling for potentially confounding sociodemographic characteristics. Results. Data were analyzed from 112 practices; median PIR at 8 and 19 months were 85% and 71%, respectively. The following policies and beliefs were not statistically associated with PIR at either 8 or 19 months: use of acute visits for vaccinations, conducting an immunization audit within the previous 12 months, perceived difficulties in implementing new vaccine recommendations or staying informed about new recommendations, conducting practice meetings to discuss immunization policies, perception of profitability of providing vaccinations, appointment reminders for scheduled visits, and specific tracking mechanisms for patients who are due for or behind in immunizations. After controlling for sociodemographic characteristics, recommending inactivated poliovirus vaccine and having fewer contraindications to vaccination were associated with statistically higher PIR at 8 months and 19 months. Increasing the maximum number of injections administered at 1 visit was associated with a higher PIR at 8 months but not 19 months of age. Conclusions. Policies and beliefs linked to many official recommendations for increasing immunization rates were not associated with higher PIR. However, accepting fewer contraindications to vaccination, administering all vaccines for which an infant is eligible at each health supervision visit, and adopting recommended changes in immunization schedules may help providers fully vaccinate a higher percentage of their patients.