title: Improving childhood immunizations in a family practice office.
abstract: OBJECTIVE
  In the fall of 1993, the Family Medicine Center (FMC) of the Medical Center of Delaware instituted an office-based program designed to improve preventive care for children. This study examined whether the "Pediatric Prevention Program" (PPP) resulted in an improvement in childhood immunization rates for FMC patients.
  
  
  METHODS
  Using chart review, we compared the percentage of two-year-old FMC patients who had completed appropriate immunizations before and after the PPP. We examined completion rates for the primary series of each immunization, for booster immunizations and for the combined total immunization series (four DPTs, three OPVs, one MMR, four HIBs). We also determined whether immunization rates were affected by patient demographics, pattern of office visits, and physician level of experience.
  
  
  RESULTS
  After implementation of the program, the percentage of 2-year-old children who had completed the appropriate immunizations increased for all types of immunizations. The increase was greatest for HIBs (6 percent for the primary HIB series and 7 percent increase for the HIB booster) and for the combined total series (10 percent increase). Children who made few office visits were the least likely to have completed immunizations, but also saw the greatest benefit from the PPP.
  
  
  CONCLUSIONS
  This study shows the positive impact of an office-based intervention for improving childhood immunizations. However, the improvements are relatively small and not sufficient to achieve optimal immunization rates throughout the community. In order to achieve these goals, additional interventions are needed which target high risk children, especially those who change physicians or who visit their physician infrequently. Targeting such children will likely require better data systems to track immunizations both in the office and across the community. These efforts should be given a high priority in Delaware.
authors.affiliation: Department of Family and Community Medicine, Medical Center of Delaware, Newark, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Gill
authors.forename: J A
authors.initials: JA
authors.lastname: Fisher
mesh_terms: D002675:Child, Preschool; D005194:Family Practice; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D010372:Pediatrics; D011322:Primary Prevention; D015397:Program Evaluation