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The delivery of immunizations and other preventive services in private practices
W C Bordley1, P A Margolis, C M Lannon
1Department of Pediatrics, University of North Carolina at Chapel Hill, 27599-7225, USA.
Insights
Many children in North Carolina private practices are not fully immunized or screened for common health issues by age two. Pediatricians often overestimate immunization rates, highlighting a need for improved preventive care delivery.
Area of Science:
- Pediatric Health Services Research
- Preventive Medicine
- Public Health Surveillance
Background:
- Assessing pediatric preventive care delivery in private practice settings is crucial for child health outcomes.
- Understanding immunization and screening rates for anemia, tuberculosis (TB), and lead poisoning is vital for early intervention.
Purpose of the Study:
- To determine the proportion of two-year-old children in North Carolina private practices who are fully immunized.
- To measure screening rates for anemia, tuberculosis (TB), and lead poisoning by age two.
- To evaluate practice-level variations in immunization and screening.
Main Methods:
- A cross-sectional chart review was conducted.
- Data were collected from 1,032 randomly selected two-year-old children across 15 private pediatric practices in central North Carolina.
- Key outcome measures included immunization status and screening for anemia, TB, and lead poisoning by 24 months of age.
Main Results:
- Only 61% of children were fully immunized by 24 months, with significant practice-level variability (38%-82%).
- Screening rates were 68% for anemia, 57% for TB, and a low 3% for lead poisoning.
- Physicians overestimated immunization rates by an average of 10%; well-child visit frequency and specific practice characteristics (e.g., use of flow sheets, nurse review of immunization status) predicted higher immunization rates.
Conclusions:
- Underimmunization and inadequate screening for key health conditions are prevalent issues in North Carolina private pediatric practices.
- Physicians demonstrate a lack of awareness regarding the actual rates of underimmunization within their own practices.
- Systemic improvements in preventive service delivery and provider education are necessary to address these gaps.
Objectives:
To measure the proportion of children cared for in private practices who are fully immunized and have been screened for anemia, tuberculosis (TB), and lead poisoning by 2 years of age.
Design:
Cross-sectional chart review.
Setting:
Fifteen private pediatric practices in central North Carolina (11 chosen randomly).
Patients:
One thousand thirty-two randomly selected 2-year-old children.
Main Outcome Measures:
Proportion of children immunized and screened for anemia, TB and lead poisoning by 24 months of age and immunization and screening rates of the practices.
Results:
Sixty-one percent of the children were fully immunized at 24 months of age; the rates among practices varied widely (38% to 82%). Sixty-eight percent of the children had been screened for anemia, 57% had been screened for TB, and 3% had been screened for lead poisoning. Physicians overestimated the proportions of fully immunized children in their practices by an average of 10% (range, -3% to 17%). The median number of well child visits by 2 years of age was 5 (range, 0 to 14), and only 19% of the entire sample made 8 or more well child visits, the number recommended by the American Academy of Pediatrics in the first 18 months of life. The numbers of well child and non-well child visits were the strongest predictors of complete immunization. Practice characteristics associated with being fully immunized included the use of preventive services prompting sheets (eg, flow sheets) in the medical records, not seeing the same physician for all well child care, and having nurses review patients' immunization status during their visits to the office.
Conclusions:
Underimmunization and inadequate screening are significant problems in private pediatric practices in North Carolina. Physicians are unaware of the rates of underimmunization in their offices.