Adolescent immunization practices -: A national survey of US physicians

Background: Adolescent immunization rates remain low. Hence, a batter understanding of the factors that influence adolescent immunization is needed. Objective: To assess the adolescent immuization practices of US physicians. Design and Setting: A 24-item survey mailed in 1997 to a national sample of 1480 pediatricians and family physicians living in the United States, randomly selected from the American Medical Association's Master List of Physicians. Participants: Of 1110 physicians (75%) who responded, 761 met inclusion criteria. Outcome Measures: Immunization practices and policies, use of tracking and recall, opinions about school based immunizations, and reasons for nut providing particular immunizations to eligible adolescents. Results: Seventy-nine percent of physicians reported using protocols for adolescent immunization, and 82% recommended hepatitis B immunization for all eligible adolescents. Those who did not routinely immunize adolescents often cited insufficient insurance coverage for immunizations. While 42% of physicians reported that they review the immunization status of adolescent patients at acute illness visits, only 24% immunized eligible adolescents during such visits. Twenty-one percent used immunization cracking and recall systems. Though 84% preferred that immunizations be administered at their practice, 71% of physicians considered schools, and 63% considered teen clinics to be acceptable alternative adolescent immunization sites. However many had concerns about continuity of care fur adolescents receiving immunizations in school. Conclusions: Most physicians supported adolescent immunization efforts. Barriers preventing adolescent immunization included financial barriers, record scattering, lack of tracking and recall, and missed opportunities. School-based immunization programs were acceptable to most physicians, despite concerns about continuity of care. Further research is needed to determine whether interventions that have successfully increased infant immunization rates al e also effective for adolescents.