Are vaccination rates higher if providers receive free vaccines and follow contraindication guidelines?
OBJECTIVE
Economics has been suggested as a barrier to vaccination, but data that link clinician reports to actual immunization rates are limited. This study examined the relationship between clinicians' self-report regarding likelihood of vaccinating and actual age at vaccination from a registry of children seen by the clinicians.


METHODS
Standardized telephone survey results of 29 providers were compared to the immunization records of children seeing these providers, using analysis of contingency tables (on time versus late) and conditional hierarchical linear models with log age at diphtheria-tetanus-pertussis (DTP)#3, DTP#4, and measles-mumps-rubella (MMR)#1 as the dependent variables.


RESULTS
Children seeing providers likely to refer an uninsured child for immunization were vaccinated at a later log age at DTP#4 but not for DTP#3 or MMR#1 than children seeing providers unlikely to refer. Vaccination rates were higher for MMR#1 (77% versus 48%), DTP#3 (84% versus 71%), and DTP#4 (82% versus 66%) among providers who received free vaccine, compared with children seen by providers who did not receive free vaccine. These results remained significant in the hierarchical analyses. Providers likely to vaccinate an 18-month-old with watery diarrhea had higher vaccination rates than those unlikely to vaccinate for MMR#1, DTP#3, and DTP#4; the results were also significant in the hierarchical analyses.


CONCLUSIONS
Children are vaccinated later in the practices of providers who are likely to refer uninsured children to a public vaccine clinic for vaccination, who do not receive free vaccine supplies, or who overinterpret contraindications.
Zimmerman
R K
RK
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, USA. zimmer+@pitt.edu
Mieczkowski
T A
TA
Michel
M
M
D000367:Age Factors; D002675:Child, Preschool; D000075202:Contraindications; D003625:Data Collection; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage* / Q000191:economics; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000706:statistics & numerical data; D008458:Measles Vaccine / Q000008:administration & dosage* / Q000191:economics; D022542:Measles-Mumps-Rubella Vaccine; D008910:Minnesota; D009108:Mumps Vaccine / Q000008:administration & dosage* / Q000191:economics; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012042:Registries; D012411:Rubella Vaccine / Q000008:administration & dosage* / Q000191:economics; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*; D017778:Vaccines, Combined / Q000008:administration & dosage / Q000191:economics
D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine; D012411:Rubella Vaccine; D017778:Vaccines, Combined