title: Barriers to measles and pertussis immunization: the knowledge and attitudes of Pennsylvania primary care physicians.
abstract: OBJECTIVE
  To understand the causes of low childhood immunization rates, physicians were interviewed about their knowledge, attitudes, and self-reported immunization practices.
  
  
  METHODS
  Trained interviewers conducted a standardized telephone survey of physicians. A random sample of Pennsylvania family physicians, pediatricians, and general practitioners younger than 65 years of age who were in office-based practices was selected from the combined listings of the American Medical Association and American Osteopathic Association. Physicians seeing > or = 5 patients per week under age 6 years, seeing a total of > or = 15 patients per week, and having > or = 50% primary care patients were eligible. Of 383 eligible physicians, 70% (268) responded. The questionnaire was designed using the Health Belief Model, immunization barriers, and input from practitioners in primary care, pediatric infectious disease, maternal/ child health, and preventive medicine.
  
  
  RESULTS
  Respondents were more likely to refer to public vaccine clinics those children without insurance (P < .001) or with Medicaid (P < .001) than children with insurance. Almost all (> 90%) respondents thought that vaccine efficacy was high and that the likelihood of serious side effects was low. However, only 37% gave estimates that corresponded with the literature regarding the likelihood of an infant with pertussis to need hospitalization. Many respondents used invalid vaccine contraindications; for instance, 37% would not administer MMR to a boy whose mother was pregnant. Many respondents (21%) would not administer four vaccines simultaneously.
  
  
  CONCLUSIONS
  If the Healthy People 2000 goal to eliminate indigenous cases of measles is to be achieved, free vaccine supplies and increased provider education are needed.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, PA 15261, USA.
authors.forename: R K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: B J
authors.initials: BJ
authors.lastname: Bradford
authors.forename: J E
authors.initials: JE
authors.lastname: Janosky
authors.forename: T A
authors.initials: TA
authors.lastname: Mieczkowski
authors.forename: E
authors.initials: E
authors.lastname: DeSensi
authors.forename: S
authors.initials: S
authors.lastname: Grufferman
mesh_terms: D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002675:Child, Preschool; D000075202:Contraindications; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007114:Immunization / Q000191:economics / Q000523:psychology*; D007115:Immunization Schedule; D007223:Infant; D007348:Insurance, Health / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008457:Measles / Q000517:prevention & control* / Q000635:transmission; D015999:Multivariate Analysis; D010414:Pennsylvania; D010821:Physicians, Family / Q000193:education / Q000523:psychology*; D011247:Pregnancy; D012017:Referral and Consultation / Q000191:economics; D012494:Sampling Studies; D014612:Vaccines / Q000008:administration & dosage / Q000191:economics; D014917:Whooping Cough / Q000517:prevention & control* / Q000628:therapy
chemical_list: D014612:Vaccines