title: Medicaid free distribution programs and availability of childhood immunizations in rural practices.
abstract: BACKGROUND
  The impact of a federal program that provides free childhood immunizations to private physicians for their Medicaid patients was examined. The aim of the study was to find out whether the program affected the availability of immunizations in rural and urban family physicians' practices.
  
  
  METHODS
  A survey form about physician practice policies was sent to a stratified sample of 1,184 urban and rural family physicians in six states. States that participated in the federal free vaccine program were matched with states in the same region that did not participate in this program.
  
  
  RESULTS
  States with no free vaccine distribution program showed a significant difference in the availability of immunizations from rural family physicians, compared with urban physicians (52% vs 87%, P < .001). However, in states with free distribution programs, no difference was found between rural and urban physicians (90% vs 94%, P = .18). In states without free distribution programs, immunization availability showed a positive and significant correlation with the size of the community where the physician practiced (Pearson correlation coefficient = .48, P < .001), whereas no correlation between community size and immunization availability existed in states with a free distribution program (Pearson correlation coefficient = .04, P = .53).
  
  
  CONCLUSIONS
  Federal programs that offer free childhood immunizations to physicians for use in Medicaid populations have a dramatic effect on increasing immunization availability in rural areas.
authors.affiliation: Department of Family Practice, University of Kentucky, Lexington, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Mainous
authors.forename: W J
authors.initials: WJ
authors.lastname: Hueston
mesh_terms: D002648:Child; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D017589:Immunization Programs; D008297:Male; D008484:Medicaid; D010821:Physicians, Family; D012423:Rural Health; D011795:Surveys and Questionnaires; D014481:United States