[vaccineinjuries] Physician knowledge of catch-up regimens and contraindications for childhood immunizations

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Subject: Fw: [vaccineinjuries] Physician knowledge of catch-up regimens and

contraindications for childhood immunizations

 

Is part of the problem that the list of contraindications needs be expanded? 

Also, that physicians need dare declare a given child to have contraindications?

1: Pediatrics. 2003 May;111(5 Pt 1):925-32.

Physician knowledge of catch-up regimens and contraindications for childhood

immunizations.

Cohen NJ, Lauderdale DS, Shete PB, Seal JB, Daum RS.

Pediatric Immunization Program, the Department of Pediatrics, University of

Chicago, Chicago, Illinois, USA.

OBJECTIVES: To determine physician success at designing catch-up regimens for

children delayed in immunizations and physician knowledge regarding

contraindications to immunization. METHODS: A self-administered survey was

completed by pediatricians, general practitioners, and family practitioners in

Cook County, Illinois. Surveys included 6 open-ended vignettes describing

hypothetical children delayed in immunization for whom participants were asked

to design catch-up regimens. Bivariate and multivariate logistic regression were

used to determine predictors of correct response. The surveys also inquired

about management of scenarios that might be perceived as contraindications to

immunize with the Haemophilus influenzae type b or measles-mumps-rubella

vaccines. RESULTS: The mean score of correct responses was 1.83 of a possible

6.0. Almost one third of respondents answered all 6 vignettes incorrectly. The

proportion of incorrect responses was high for all

6 vignettes (39%-86%), but higher for questions that addressed the immunization

of children older than 12 months. Errors in vaccine administration were most

commonly attributed to omitted vaccines, with varicella-zoster vaccine and

pneumococcal conjugate vaccine omitted most frequently. Pediatricians were >4

times more likely to answer correctly than were family practitioners.

Participants in the Vaccines for Children (VFC) program were more than twice as

likely to answer correctly than were non-VFC providers. Knowledge of

contraindications was inconsistent, particularly for measles-mumps-rubella

vaccine. CONCLUSIONS: Childhood vaccine providers have substantial knowledge

deficits of recommended immunization schedules and vaccine contraindications

that may contribute to missed opportunities to immunize. Pediatricians and

participants in the VFC program were more successful at designing catch-up

regimens for children with immunization delay.

PMID: 12728067» See all Related Articles...

2: Pediatrics. 2002 Feb;109(2):294-300. Links

Practitioner policies and beliefs and practice immunization rates: a study from

Pediatric Research in Office Settings and the National Medical Association.

JA, Darden PM, DA, Hendricks JW, Baker AE, Wasserman RC.

Department of Pediatrics, University of Washington, Seattle, Washington, USA.

uncjat@...

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 contraindication

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. CONCLUSION:

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.

PMID: 11826210» See all Related Articles...

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