title: Childhood immunization availability in primary care practices. Effects of programs providing free vaccines to physicians.
abstract: OBJECTIVE
  To examine state immunization distribution programs, along with physician practice, training, and attitudinal factors that influence the availability of childhood immunizations in community practices.
  
  
  METHODS
  Multistate survey stratified by rural and urban practice.
  
  
  METHODS
  Family physicians in community practices in three states that offer free vaccines to physicians for use in Medicaid recipients (n = 287) and three geographically matched states that do not offer free vaccines (n = 266).
  
  
  RESULTS
  Physicians practicing in states that offer free vaccines for use in Medicaid populations were more likely to offer immunizations to patients in their practices (92% vs 75%, respectively; P < .001). This difference persisted even after adjusting for other practice variables that are associated with immunization availability. Physicians who did not offer immunizations cited cost factors as the primary reason for not offering this service. Public health departments were used as the referral site for immunization services, but only 59% of the physicians performed follow-up to determine whether patients received immunizations.
  
  
  CONCLUSIONS
  State immunization programs that provide vaccines free to physicians are highly associated with practice policies that increase immunization availability.
authors.affiliation: Department of Family Medicine, Eau Claire Family Practice Residency, University of Wisconsin.
authors.forename: W J
authors.initials: WJ
authors.lastname: Hueston
authors.forename: A G
authors.initials: AG
authors.lastname: Mainous
authors.forename: J B
authors.initials: JB
authors.lastname: Farrell
mesh_terms: D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005194:Family Practice / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D007223:Infant; D016015:Logistic Models; D008484:Medicaid; D009513:New Hampshire; D010818:Practice Patterns, Physicians'; D011365:Professional Practice Location; D012424:Rural Population; D013023:South Dakota; D014481:United States; D014505:Urban Population; D014861:Washington