The relation of parent and provider characteristics to vaccination status of children in private practices and managed care organizations in Maryland.
OBJECTIVE
This study sought to identify provider practices and policies in private pediatric settings that relate to vaccination status, controlling for the characteristics of the children served.


METHODS
Vaccination data came from the medical records of 709 randomly selected 2-year-old children at 18 private practices and managed care organizations in Maryland, family data from 466 telephone interviews with the children's parents, and provider characteristics from 18 site questionnaires and 42 individual physician and nurse practitioner questionnaires. Logistic regression and generalized estimating equations were used to estimate the relation of provider characteristics to vaccination status. Three age-appropriate (AA) and two up-to-date (UTD) vaccination status variables characterized successful vaccination.


RESULTS
Approximately 70% of the study children were up-to-date by age 2 years for the full vaccination series, excluding hepatitis B vaccine. Family demographic characteristics were the strongest correlates of undervaccination. Neither parents' knowledge and attitudes about immunization nor the children's insurance coverage was statistically related to vaccination status. Site reminder or follow-up systems and provider perceptions about appointment scheduling and receipt of vaccine information from health departments were positively related to vaccination. Concern for liability was associated with a reduced odds of age-appropriate and up-to-date vaccination.


CONCLUSIONS
Family demographics strongly correlate with vaccination status; however, they are generally not modifiable. This study's findings encourage providers to operate a tracking system, to remain current on immunization recommendations, to use all clinical encounters to screen and vaccinate children, and to ensure the availability and convenience of vaccination services.
Department of Maternal and Child Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA. nhughart@jhsph.edu
N
N
Hughart
D
D
Strobino
E
E
Holt
B
B
Guyer
W
W
Hou
A
A
Huq
A
A
Ross
D000367:Age Factors; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008396:Maryland; D010290:Parents / Q000193:education / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011331:Private Practice / Q000458:organization & administration*; D044469:Racial Groups; D017010:Reminder Systems; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*