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Periodic Survey #66 Pediatricians' Attitudes and Practices Surrounding the Delivery of Immunizations

(Part 2) - Communication and Documentation of Vaccine Risks/Benefits
Periodic Survey of Fellows
American Academy of Pediatrics
Division of Health Policy Research

Executive Summary

This survey was initiated by the former Committee on Community Health Services to explore issues surrounding immunizations, including pediatricians’ attitudes and practices regarding communication and documentation of vaccine risks/benefits. The survey was developed in cooperation with the National Immunization Program at the Centers for Disease Control and Prevention (CDC) and findings will assist the AAP/CDC Childhood Immunization Support Program (CISP) in evaluating and promoting national immunization practices. PS#66 was funded by the DHHS, CDC, National Immunization Program as part of the CISP grant, #U66/CCU524285.

PS#66 also included questions on attitudes toward universal influenza immunization, practices regarding recently recommended vaccines, opinion on adequacy of vaccine and administration cost reimbursement levels, and satisfaction with the AAP as an information source on immunizations; these findings are reported in separate Executive Summaries. Selected findings from PS#66 were presented at the 2007 annual meeting of the Pediatric Academic Societies.

PS#66 was mailed to a random sample of 1620 non-retired U.S. members of the Academy. An original mailing and six follow-up mailings to recontact nonrespondents were conducted from July through November 2006; 852 questionnaires were received for a response rate of 53%. Analysis for the following topics was limited to 629 pediatricians who provide patient care and offer age-appropriate immunizations to all or some of the children in their practice.

Two of the questions on this survey covering documentation of vaccine refusal replicate those asked on PS#48, 2001 (N=1622, response rate=64%), initiated by the Committee on Medical Liability (COML).

Vaccine Refusals, 2006:

  • In 2006, three-fourths of pediatricians (74%) report having had one or more parents in their practice refuse permission for one or more vaccinations during the past year.

    • These pediatricians report an average of 5% of all parents refused one vaccine, 3% of all parents refused some vaccines (more than 1 but less than all), and 2% refused all vaccines during the past year.

    • The most common reasons parents give for refusing vaccination include concern about thimerasol and autism (74% of pediatricians reporting) and other concerns about vaccine safety or adverse side effects (73% reporting); 63% of pediatricians say parents refused vaccinations because of belief that immunization is unnecessary, and 42% say parents cite discomfort to the child of having too many shots at one time. (multiple response was possible)

  • In 2006, pediatricians report 32% of parents who initially refused a vaccine during the past year changed their mind after educational efforts and gave permission for the vaccine.

Vaccine Risks/Benefits – Communication/Documentation, 2001 vs 2006:

The following questions on methods of handling vaccine risk/benefit communication and documentation were previously asked on PS#48 in 2001 (N=1622, response rate=64.1%).

  • In both 2006 and 2001, nearly all pediatricians reported always making an attempt to educate parents who refused a vaccine about the importance and safety of the immunization (96% in both years), and always documenting the refusal in the patient’s record (96% in both years).

Vaccine Risks/Benefits – Communication/Documentation, 2001 vs 2006

  • About three-fourths of pediatricians in both survey years always document the provision of information on vaccine risks/benefits (78% in 2006, 72% in 2001).

  • The proportion of pediatricians who report they always obtain a parent’s signature as evidence of having received information and refusal has increased over survey years from 24% in 2001 to 37% in 2006 (p.<.001).

  • If, after educational efforts, parents continue to refuse permission for a vaccine, a similar proportion of pediatricians in 2006 and 2001report routinely (6%, 5%) or sometimes (16%, 18%) refusing to continue to be their doctor. Most pediatricians in both survey years say lack of trust is the primary reason for dismissing from the practice those patients whose parents refused permission for an immunization (88%, 79%).

    • Asked in 2006 only, pediatricians report dismissing an average of 6% of patients whose parents continually refused permission for a vaccine after educational efforts.

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