DELAYS IN CHILDHOOD IMMUNIZATIONS IN PUBLIC AND PRIVATE SETTINGS

Background: As the costs of childhood immunizations have increased over the past 10 years, patients have increasingly turned to public health departments for this service. This study compares reasons for delays in immunization among patients who obtained their immunizations at health departments and those who continued to utilize private physicians or clinics. Methods: A birth certificate survey of all children born between September 1, 1988, and August 31, 1989, in four urban census tracts and two rural counties in Kentucky was performed in late 1991, when all children were over age 2 years. The percentage of patients whose immunizations had been delayed and the reasons for delay were noted. Results: Children who utilized public health departments or a combination of health departments and private sources for their immunizations were more likely to have experienced delays than those who obtained immunizations from private providers (56% vs 34%, P=.002). In particular, patients in the public provider group were more likely than those in the private provider group to have missed immunizations for invalid contraindications (34% vs 8%, P=.02), missed appointments (22% vs 9%, P=.02), or failure to receive immunizations when at the health department for another visit (23% vs 11%, P=.04). Conclusions: While a large number of patients in both the private and public provider groups experienced delays in immunizations, patients who received immunizations from public sources were more likely to experience delays related to missed opportunities.