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Would better adherence to guidelines improve childhood immunization rates?
T A Lieu1, S B Black, M E Sorel
1Division of Research, Permanente Medical Group, Oakland, California, USA.
Pediatrics
|December 1, 1996
Summary
Provider practices significantly impact childhood underimmunization, even with vaccine coverage. Simultaneously administering all eligible vaccines offers the greatest potential to improve immunization rates in children.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Underimmunization remains a concern for children with insurance coverage for vaccines.
- Provider practices are potential targets for interventions to improve vaccination rates.
Purpose of the Study:
- To evaluate the contribution of specific provider practices to childhood underimmunization.
- To assess the effectiveness of three guidelines in improving vaccine coverage.
Main Methods:
- Retrospective cohort study of 24,268 children aged 15-24 months in a large health maintenance organization.
- Analysis of computerized databases and chart reviews for children who missed immunizations.
Main Results:
- 57% of underimmunized children had clinic visits but did not receive all eligible vaccines simultaneously.
- Simultaneous vaccine administration could have fully immunized 30% of underimmunized children.
- Urgent visits could potentially reach 27% of underimmunized children, with no contraindications found in most cases.
Conclusions:
- Provider practices are crucial in addressing childhood underimmunization.
- Simultaneous administration of all possible vaccines is the most effective strategy to improve coverage.
- Utilizing urgent visits for immunization is a potentially effective strategy requiring further logistical and cost analysis.