Factors responsible for immunizations referrals to health departments in North Carolina
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W C Bordley1, G L Freed, J M Garrett
1Department of Pediatrics, University of North Carolina at Chapel Hill 27599-7590.
Insights
Despite existing programs, many children are referred to health departments for immunizations. Physician concerns about parental payment ability and program issues hinder in-office vaccinations for Medicaid patients.
Area of Science:
- Pediatrics
- Public Health
- Health Policy
Background:
- Cost barriers and existing programs like Medicaid do not fully prevent immunization referrals to health departments.
- Many children leave physician offices without receiving necessary vaccinations, indicating a gap in care delivery.
Purpose of the Study:
- To assess the frequency and reasons for immunization referrals to health departments in North Carolina.
- To identify factors influencing private physicians' decisions regarding immunizing Medicaid children in-office and participating in vaccine replacement programs.
Main Methods:
- A mail survey was conducted among 2537 licensed pediatricians and family physicians in North Carolina.
- A 23-item self-administered questionnaire was used to gather data on referral practices and program participation.
Main Results:
- 93% of responding physicians referred children to health departments, primarily due to concerns about parental payment ability.
- 40% referred Medicaid patients, citing excessive paperwork, low reimbursement, and parental preferences as key reasons.
- Only 33% participated in the state's vaccine replacement program; rural, solo/small practices with fewer Medicaid patients were more likely to refer and not participate.
Conclusions:
- Current Medicaid and state vaccine programs are insufficient to reduce immunization referrals to health departments.
- Future initiatives must offer more effective physician incentives to increase in-office childhood immunizations.
Background:
Despite the existence of Medicaid and other programs designed to eliminate cost as a barrier to immunization in physicians' offices, referrals to local health departments for immunizations are common. Many children leave their physicians' offices without receiving needed immunizations.
Purpose:
To determine: 1) the frequency and determinants of immunization referrals to health departments in North Carolina, and 2) the factors associated with private physicians' decisions to immunize Medicaid children in their offices and participate in the state-funded vaccine replacement program.
Methods:
The 2537 pediatricians and family physicians licensed in North Carolina were surveyed by mail using a 23-item, self-administered questionnaire.
Results:
Seventy-two percent of physicians responded; 93% referred at least some children to local health departments for immunizations. Concern regarding parents' ability to pay for immunizations was the most important reason for referral for 93% of respondents. Forty percent referred all or some of their Medicaid patients; excessive paperwork, inadequate reimbursement, and parental preferences were the most common reasons. Only 33% of physicians had participated in the state's vaccine replacement program. Family physicians, and physicians in solo or two-physician practices in rural counties, and in practices caring for a small number of children on Medicaid were most likely to refer children covered by Medicaid and not participate in the state's existing vaccine replacement program.
Conclusions:
Medicaid and North Carolina's vaccine replacement program are not preventing large numbers of immunization referrals to health departments. Future programs designed to increase the proportion of children immunized in physicians' offices will not succeed if more effective incentives for physician participation are not developed.