The delivery of immunizations and other preventive services in private practices.
OBJECTIVE
To measure the proportion of children cared for in private practices who are fully immunized and have been screened for anemia, tuberculosis (TB), and lead poisoning by 2 years of age.


METHODS
Cross-sectional chart review.


METHODS
Fifteen private pediatric practices in central North Carolina (11 chosen randomly).


METHODS
One thousand thirty-two randomly selected 2-year-old children.


METHODS
Proportion of children immunized and screened for anemia, TB and lead poisoning by 24 months of age and immunization and screening rates of the practices.


RESULTS
Sixty-one percent of the children were fully immunized at 24 months of age; the rates among practices varied widely (38% to 82%). Sixty-eight percent of the children had been screened for anemia, 57% had been screened for TB, and 3% had been screened for lead poisoning. Physicians overestimated the proportions of fully immunized children in their practices by an average of 10% (range, -3% to 17%). The median number of well child visits by 2 years of age was 5 (range, 0 to 14), and only 19% of the entire sample made 8 or more well child visits, the number recommended by the American Academy of Pediatrics in the first 18 months of life. The numbers of well child and non-well child visits were the strongest predictors of complete immunization. Practice characteristics associated with being fully immunized included the use of preventive services prompting sheets (eg, flow sheets) in the medical records, not seeing the same physician for all well child care, and having nurses review patients' immunization status during their visits to the office.


CONCLUSIONS
Underimmunization and inadequate screening are significant problems in private pediatric practices in North Carolina. Physicians are unaware of the rates of underimmunization in their offices.
Bordley
W C
WC
Department of Pediatrics, University of North Carolina at Chapel Hill, 27599-7225, USA.
Margolis
P A
PA
Lannon
C M
CM
D000740:Anemia / Q000517:prevention & control; D003430:Cross-Sectional Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D005544:Forecasting; D018073:Haemophilus Vaccines / Q000008:administration & dosage; D006293:Health Promotion / Q000706:statistics & numerical data; D007114:Immunization / Q000706:statistics & numerical data*; D007855:Lead Poisoning / Q000517:prevention & control; D008403:Mass Screening / Q000706:statistics & numerical data; D008458:Measles Vaccine / Q000008:administration & dosage; D022542:Measles-Mumps-Rubella Vaccine; D008499:Medical Records; D009108:Mumps Vaccine / Q000008:administration & dosage; D009657:North Carolina / Q000453:epidemiology; D009723:Nurse-Patient Relations; D009819:Office Visits / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage; D011315:Preventive Medicine / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012411:Rubella Vaccine / Q000008:administration & dosage; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control; D017778:Vaccines, Combined / Q000008:administration & dosage
D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine; D011055:Poliovirus Vaccine, Oral; D012411:Rubella Vaccine; D017778:Vaccines, Combined