Adolescent immunization practices: a national survey of US physicians.
BACKGROUND
Adolescent immunization rates remain low. Hence, a better understanding of the factors that influence adolescent immunization is needed.


OBJECTIVE
To assess the adolescent immunization practices of US physicians.


METHODS
A 24-item survey mailed in 1997 to a national sample of 1480 pediatricians and family physicians living in the United States, randomly selected from the American Medical Association's Master List of Physicians.


METHODS
Of 1110 physicians (75%) who responded, 761 met inclusion criteria.


METHODS
Immunization practices and policies, use of tracking and recall, opinions about school-based immunizations, and reasons for not providing particular immunizations to eligible adolescents.


RESULTS
Seventy-nine percent of physicians reported using protocols for adolescent immunization, and 82% recommended hepatitis B immunization for all eligible adolescents. Those who did not routinely immunize adolescents often cited insufficient insurance coverage for immunizations. While 42% of physicians reported that they review the immunization status of adolescent patients at acute illness visits, only 24% immunized eligible adolescents during such visits. Twenty-one percent used immunization tracking and recall systems. Though 84% preferred that immunizations be administered at their practice, 71% of physicians considered schools, and 63% considered teen clinics to be acceptable alternative adolescent immunization sites. However, many had concerns about continuity of care for adolescents receiving immunizations in school.


CONCLUSIONS
Most physicians supported adolescent immunization efforts. Barriers preventing adolescent immunization included financial barriers, record scattering, lack of tracking and recall, and missed opportunities. School-based immunization programs were acceptable to most physicians, despite concerns about continuity of care. Further research is needed to determine whether interventions that have successfully increased infant immunization rates are also effective for adolescents.
Schaffer
S J
SJ
Division of General Pediatrics, Box 777, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA. Stanley_Schaffer@urmc.rochester.edu
Humiston
S G
SG
Shone
L P
LP
Averhoff
F M
FM
Szilagyi
P G
PG
D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards / Q000706:statistics & numerical data*; D002644:Chickenpox / Q000517:prevention & control; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007114:Immunization / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D007349:Insurance, Health, Reimbursement; D008297:Male; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012044:Regression Analysis; D012572:School Health Services; D014481:United States