PRACTITIONER POLICIES AND BELIEFS AND PRACTICE IMMUNIZATION RATES: A STUDY FROM PROS AND THE NATIONAL MEDICAL ASSOCIATION (NMA) JA Taylor, PM Darden, DA Brooks, K Rohder. Pediatrics, University of Washington, Seattle, WA; Pediatrics, Medical University of South Carolina, Charleston, SC; Pediatrics, Johns Hopkins University, Baltimore, MD; and Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL. Presented as a platform presentation at the 2000 Pediatric Academic Societies? Annual Meeting.

OBJECTIVE: To determine the effect of practitioner policies and beliefs on the immunization status of their patients, and to identify specific policies that are associated with high levels of fully immunized children.

DESIGN/METHODS: As part of an ongoing study, pediatricians in 74 practices throughout the US collected immunization data on a consecutive sample of children, 8-35 months old, seen in their offices. All participating pediatricians were members of PROS or the NMA. A practice-specific immunization rate was estimated by the proportion of age eligible children who had received 4 DTP, 3 polio, 3 Hib, 1 MMR, and 3 Hepatitis B vaccines before they were 19 months of age. Prior to collecting immunization data, practitioners in each practice completed a survey on their office policies regarding vaccination practices, and their beliefs about the provision of immunizations. For each practice a single response for each item on the survey was calculated by averaging the responses of every practitioner in that practice. Regression analyses were performed to assess the association between each policy/belief and practice immunization rates, after adjusting for pediatrician age, type of practice organization, and educational level of the mothers of the children in the sample.

RESULTS: The median practice immunization rate was 72% (range 18%-96%). Policies/beliefs not significantly associated with immunization rates included: using acute visits for vaccines (P=.8), conducting audits (P=.8), meeting regularly to discuss immunization policies (P=.5), patient reminders for scheduled visits (P=.5), tracking of patients' immunization status (P=.2), and perceived profitability of providing vaccines (P=.6); perceived ease of understanding and implementing new immunization policies (P=.08), and preference for administering higher numbers of immunizations at one visit (P=.1) were of borderline statistical significance. The more contraindications to DTaP vaccination that a practice endorsed, the lower their immunization rate was (P=.04). Finally, recommending IPV rather than another polio vaccine policy was associated with higher immunization rates (P=.002). In the model, practice immunization rate was estimated to decrease 2% for each contraindication endorsed, and increase 14% for recommending IPV.

CONCLUSION: Adopting new vaccine recommendations and having fewer vaccine contraindications may indicate greater practice emphasis on achieving high immunization rates.