title: Factors responsible for immunizations referrals to health departments in North Carolina.
abstract: BACKGROUND
  Despite the existence of Medicaid and other programs designed to eliminate cost as a barrier to immunization in physicians' offices, referrals to local health departments for immunizations are common. Many children leave their physicians' offices without receiving needed immunizations.
  
  
  OBJECTIVE
  To determine: 1) the frequency and determinants of immunization referrals to health departments in North Carolina, and 2) the factors associated with private physicians' decisions to immunize Medicaid children in their offices and participate in the state-funded vaccine replacement program.
  
  
  METHODS
  The 2537 pediatricians and family physicians licensed in North Carolina were surveyed by mail using a 23-item, self-administered questionnaire.
  
  
  RESULTS
  Seventy-two percent of physicians responded; 93% referred at least some children to local health departments for immunizations. Concern regarding parents' ability to pay for immunizations was the most important reason for referral for 93% of respondents. Forty percent referred all or some of their Medicaid patients; excessive paperwork, inadequate reimbursement, and parental preferences were the most common reasons. Only 33% of physicians had participated in the state's vaccine replacement program. Family physicians, and physicians in solo or two-physician practices in rural counties, and in practices caring for a small number of children on Medicaid were most likely to refer children covered by Medicaid and not participate in the state's existing vaccine replacement program.
  
  
  CONCLUSIONS
  Medicaid and North Carolina's vaccine replacement program are not preventing large numbers of immunization referrals to health departments. Future programs designed to increase the proportion of children immunized in physicians' offices will not succeed if more effective incentives for physician participation are not developed.
authors.affiliation: Department of Pediatrics, University of North Carolina at Chapel Hill 27599-7590.
authors.forename: W C
authors.initials: WC
authors.lastname: Bordley
authors.forename: G L
authors.initials: GL
authors.lastname: Freed
authors.forename: J M
authors.initials: JM
authors.lastname: Garrett
authors.forename: C A
authors.initials: CA
authors.lastname: Byrd
authors.forename: R
authors.initials: R
authors.lastname: Meriwether
mesh_terms: D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007114:Immunization / Q000191:economics / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics*; D009657:North Carolina; D010372:Pediatrics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013219:State Government; D014481:United States