A National Survey to Understand Why Physicians Defer Childhood Immunizations

Richard Kent Zimmerman

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Vaccine Coverage and Hesitancy Child and Adolescent Health Intramuscular injections and effects

Abstract

OBJECTIVE: To determine the causes of low childhood immunization rates based on physicians' knowledge, attitudes, and self-reported practices concerning childhood immunization. DESIGN: A standardized telephone survey conducted by trained interviewers. SETTING: Primary care physicians across the United States. PARTICIPANTS: A stratified random sample of office-based family physicians, pediatricians, and general practitioners younger than 65 years was selected from the American Medical Association master file list that includes nonmembers. Physicians seeing 5 or more patients per week younger than 6 years and having 50% or more primary care patients were eligible for study. Of 1769 eligible physicians who spoke directly with the interviewers, 70% (N = 1241) completed the questionnaire. INTERVENTIONS: The interview was designed to determine physicians' likelihood of recommending vaccination in common clinical scenarios and to probe reasons behind these decisions. RESULTS: Only 4% of physicians who thought the risk for side effects was increased by upper respiratory tract infection (URI) were likely to vaccinate a child with URI vs 55% of physicians who thought there would be no increased risk (P < .001). Eighty-three percent of those who thought the efficacy of measles, mumps, and rubella vaccine would not be affected by a URI recommended vaccination vs only 8% of physicians who thought efficacy would decrease (P < .001). Some respondents (11%) would not administer 3 injectable vaccines simultaneously based on beliefs about side effects, parental objections, and vaccine efficacy. Physicians' likelihood of vaccination also varied by type of visit: 47% were less likely to vaccinate a child with a URI in an acute care as opposed to a well-child setting. CONCLUSION: Physicians' beliefs and practice policies materially influence their likelihood of recommending vaccinations.

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References

1991The Measles Epidemic 1993Standards for Pediatric Immunization Practices 1993Missed Opportunities for Childhood Vaccinations in Office Practices and the Effect on Vaccination Status 1981Women in Medical Education 1994Immunization Practices of Pediatricians and Family Physicians in the United States 1992Immunization Opportunities Missed Among Urban Poor Children 1994Too many shots? Parent, nurse, and physician attitudes toward multiple simultaneous childhood vaccinations 1995Vaccination levels in Los Angeles public health centers: the contribution of missed opportunities to vaccinate and other factors.

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