ABSTRACT

Presented at the Pediatric Academic Societies annual meeting, May 1999

POLIO IMMUNIZATION PRACTICES OF PEDIATRICIANS. Pm Darden, JA Taylor, DA Brooks, AE Baker, KG O'Connor, AB Bocian. Dept of Pediatrics, MUSC, Charleston, SC; Dept of Pediatrics, Univ of Washington, Seattle, WA; Dept of Pediatrics, Johns Hopkins Univ, Baltimore, MD; Pediatric Research in Office Settings, Center for Child Health Research, AAP, Elk Grove Village, IL; Division of Health Policy Research, Dept of Pediatric Practice and Research, AAP, Elk Grove Village, IL

Objective: To describe pediatricians' use of polio vaccines and associated immunization behaviors.

Design/Methods: A survey on immunization practices was mailed to a random selection of 1626 fellows of the American Academy of Pediatrics (AAP Periodic Survey #39), with a response rate of 76%. Results reported here reflect data from the 731 pediatricians who indicated that they provide primary care including immunizations. Characteristics of physicians using a polio vaccine schedule that included IPV were compared to those of pediatricians using all OPV or no specific schedule. Group comparisons were performed using chi-square tests.

Results: Most pediatricians, 70%, reported that they recommend the sequential IPV/OPV schedule, 5% all IPV, 16% all OPV and 9% no specific poliovaccine schedule. Physicians participating in bulk purchase programs were more likely to recommend IPV containing schedules (76% vs 67% of non-participants, p=0.03). Conversely, male pediatricians and those who care for a larger proportion of patients, <3 years of age were less likely to recommend IPV (p=0.01 for both comparisons). In deciding which poliovaccine to recommend, 61% of pediatricians reported that risk to patients, and 48% that official recommendations were important factors. Cost and availability of vaccine were important to only 12% and 29% of pediatricians respectively. The number of injections needed to immunize a child was somewhat important in the decision of which poliovaccine to use for 52% of respondents. Most (76%) responding pediatricians report "almost always" discussing the alternate poliovaccine schedules, while 9% report "rarely" discussing this issue. Most (79%) report that parents expect the physician or nurse to guide them in their decision.

Overall, pediatricians were willing to give more injections at one visit than they perceived parents as willing to accept (mean, 3.9 vs 3.6 injections, respectively, p<0.01, paired t-test). Virtually all pediatricians (96%) reported that immunization summary sheets were present in the practice medical record. A minority (37%) reported conducting an immunization audit of their practice within the preceding 12 months.

Conclusions: Three-quarters of pediatricians are recommending an IPV-containing vaccine schedule for their patients. Pediatricians feel that parents are relying on them for guidance in making decisions regarding the appropriate poliovaccine schedule. Pediatricians are commonly using patient specific aids to immunization (such as immunization summary sheets), but are not using practice audits, a tool that may help to increase practice-specific immunization rates.