Childhood immunization in rural family and general practices: current practices, perceived barriers and strategies for improvement

Abstract

ABSTRACT Objective Immunizations are an important component of well child care, yet children around the world are commonly not fully immunized. The goal of this research was to assess current immunization practices, perceived barriers to immunization, and identify strategies that might improve immunization rates. Design setting and measurement Rural family and general practitioners in the 52 nonmetropolitan statistical area counties of Colorado who might include the care of children in their practice were surveyed regarding their immunization practices. Responses were used to identify ways in which these physicians comply with published standards for immunization practices and the barriers they perceived to immunization. Results Nearly all rural Colorado family and general practitioners provide services to children, and most currently provide immunizations. The majority send at least some of their patients to other sources of care for immunizations. Common deficiencies in immunization practices and patient barriers are similar to those encountered internationally. These include not immunizing at sick visits, not providing for ‘walk‐in’ immunizations, not making immunization available during evenings and weekends, failing to perform immunization screening at every visit and having no formal reminder or tracking systems. Patient barriers include cost, parental attitudes, language barriers, transportation and patient mobility. Provider barriers are lack of availability of immunization records (immunization tracking), low reimbursement rates, problems with keeping small volumes of vaccines, record‐keeping problems and their own failure to counsel parents about the importance of immunization, to immunize at sick visits and to screen for immunization status at all visits. Implications for practice Rural family physicians and general practitioners are well positioned to have a positive impact on childhood immunization rates, as they provide the majority of care to rural children. Better adherence to standards for immunization practice should help improve immunization rates. Problems related to reimbursement and immunization tracking are likely to remain.

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