title: Does the Vaccines for Children program influence pediatric nurse practitioner referral of disadvantaged children to public vaccine clinics?
abstract: OBJECTIVE
  Concerns about financial barriers to vaccination led to the creation of the Vaccines for Children (VFC) program, which provides free vaccines to states for disadvantaged children. Our objective was to understand the effect of free vaccine and insurance on pediatric nurse practitioners' (PNPs) likelihood of referring children to public vaccine clinics. Although referral from the medical home to public vaccine clinics is preferable to not vaccinating, there are disadvantages, including the potential for windows of inadequate protection and fragmentation of care.
  
  
  METHODS
  A standardized survey was conducted by trained personnel using computer-assisted telephone interviewing. We interviewed a national random sample of primary care PNPs in 1997.
  
  
  RESULTS
  In 1997, 252 of 271 (93%) directly contacted PNPs were interviewed. The percentage of respondents receiving free vaccines was 82%. Among PNPs not receiving free vaccines, the percentages stating that they were likely to refer insured, Medicaid insured, and uninsured children to public vaccine clinics were 7%, 27%, and 67%, respectively. In contrast, among PNPs receiving free vaccines, only 46% would refer an uninsured child and 10% a Medicaid child.
  
  
  CONCLUSIONS
  Most respondents received free vaccine supplies in 1997. Based on current PNP data and previous physician data, most clinicians who do not receive free vaccine supplies are likely to refer uninsured children to public vaccine clinics. In contrast, clinicians who receive free vaccine supplies are much more likely to vaccinate uninsured and Medicaid-insured children.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, School of Medicine, University of Pittsburgh, Pennsylvania 15261, USA. zimmer+@pitt.edu
authors.forename: R K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: S N
authors.initials: SN
authors.lastname: Van Cleve
authors.forename: A R
authors.initials: AR
authors.lastname: Medsger
authors.forename: M
authors.initials: M
authors.lastname: Raymund
authors.forename: J A
authors.initials: JA
authors.lastname: Ball
mesh_terms: D002662:Child Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003625:Data Collection; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007223:Infant; D009722:Nurse Practitioners; D011203:Poverty; D011635:Public Health Administration; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms; D014481:United States; D014612:Vaccines / Q000191:economics / Q000600:supply & distribution
chemical_list: D014612:Vaccines