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Family physician acceptance of universal hepatitis B immunization of infants
G L Freed1, W C Bordley, S J Clark
1Division of Community Pediatrics, University of North Carolina, Chapel Hill 27599-7490.
Insights
The Centers for Disease Control (CDC) has an ineffective dissemination mechanism for new hepatitis B immunization recommendations to family physicians. Practical concerns regarding multiple injections hinder adoption of universal infant immunization.
Area of Science:
- Public Health
- Immunization Policy
- Family Medicine
Background:
- Hepatitis B infection incidence increased 37% in the US over a decade, leading to 300,000 new infections and 5,000 deaths annually.
- Previous immunization programs targeting high-risk groups were ineffective, prompting the CDC to recommend universal infant hepatitis B immunization in 1991.
- This study assesses the dissemination effectiveness of the CDC's new recommendation, its impact on clinical practice, and barriers to adoption.
Purpose of the Study:
- Evaluate the effectiveness of the Centers for Disease Control (CDC) in disseminating new hepatitis B immunization recommendations to family physicians.
- Assess the impact of the new recommendation on family physicians' clinical practices.
- Determine the extent to which non-economic barriers influence the adoption of universal hepatitis B immunization for infants.
Main Methods:
- A random sample of 300 North Carolina family physicians was surveyed via mail.
- Descriptive statistics and chi-square analysis were employed to identify predictors of physician awareness and agreement with the new recommendation.
- A response rate of 78% was achieved.
Main Results:
- Only 48% of family physicians administering child immunizations were aware of the universal hepatitis B vaccine recommendation.
- Just 17% of physicians agreed that the vaccine was warranted for all newborns in their practice.
- Physicians anticipated significant parental (25%) and nursing staff (42%) resistance to administering three injections at a single well-child visit.
Conclusions:
- The CDC's current information dissemination mechanisms are insufficient for reaching all physicians providing pediatric care.
- Enhanced coordination between the CDC and specialty societies is crucial for increasing physician adoption of new immunization guidelines.
- Addressing practical concerns, such as multiple injections, is essential for the successful implementation of new immunization recommendations.
Background:
The incidence of hepatitis B infection has risen 37% over the last decade; 300,000 new infections and 5000 deaths occur annually in the United States. Because immunization programs that targeted high-risk groups failed to abate this increase, the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation to family physicians, (2) the effect of the new recommendation on clinical practice, and (3) the degree to which noneconomic barriers may affect adoption of universal hepatitis B immunization.
Methods:
A random sample of 300 family physicians in North Carolina was surveyed by mail. Descriptive statistics and chi-square analysis were used to assess the relationship of variables hypothesized to predict physician awareness of, and agreement with, the new recommendation.
Results:
The response rate was 78%. Overall, 48% of family physicians who administered immunizations to children were aware of the new hepatitis B vaccine recommendation. However, only 17% agreed that it was warranted for all newborns in their practice. Twenty-five percent expected more than one half of the parents to refuse three injections at a single well-child visit, a result of adding this vaccine to the current primary immunization schedule. Additionally, 42% expected nurses to resist giving three injections at one visit.
Conclusions:
The CDC does not have an effective mechanism for disseminating information to all physicians who care for children. Improved coordination of recommendations between the CDC and relevant specialty societies may help to increase physician adoption of new immunization recommendations in their clinical practice. Additionally, practical concerns of physicians and their patients regarding multiple injections and other practice-relevant issues must be considered when formulating new immunization recommendations, if their implementation is to be successful. Additional research is needed to determine effective methods to disseminate immunization information and to address practical concerns of clinicians.