title: Pediatricians' self-reported clinical practices and adherence to national immunization guidelines after the introduction of pneumococcal conjugate vaccine.
abstract: BACKGROUND
  Little is known about whether pneumococcal conjugate vaccine (PCV) has altered pediatricians' practices regarding well-child and acute care.
  
  
  OBJECTIVE
  To (1) describe whether PCV caused pediatricians to move other routine infant vaccines and/or add routine visits; (2) characterize adherence to national immunization recommendations; and (3) determine whether PCV altered pediatricians' planned clinical approach to well-appearing febrile infants.
  
  
  METHODS
  One year after PCV was added to the pediatric immunization schedule, we mailed a 23-item survey to 691 randomly selected pediatricians in Massachusetts. The adjusted response rate was 77%.
  
  
  RESULTS
  After PCV introduction, 39% of pediatricians moved other routine infant vaccines to different visits and 15% added routine visits to the infant schedule. The self-reported immunization schedules of 36% were nonadherent to national immunization guidelines for at least 1 vaccine. Nonadherence rates were significantly higher among pediatricians who had been in practice longer, moved another vaccine because of PCV introduction, and/or offered to give shots later when multiple injections were due. For a hypothetical febrile 8-month-old girl who had received 3 doses of PCV, pediatricians reported they were significantly less likely to (1) perform both blood and urine testing and (2) prescribe antibiotics than in the pre-PCV era.
  
  
  CONCLUSIONS
  The introduction of PCV may have had unintended effects on pediatric primary care, including decreased adherence to national recommendations for the timing of immunizations and decreased urine testing for well-appearing febrile infants. Special efforts may be warranted to ensure that pediatricians remain current with changing recommendations.
authors.affiliation: Harvard Pediatric Health Services Research Fellowship, Boston, MA 02215, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Lee
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Irina L
authors.initials: IL
authors.lastname: Miroshnik
authors.forename: Donna
authors.initials: D
authors.lastname: Rusinak
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Santoli
authors.forename: Susan M
authors.initials: SM
authors.lastname: Lett
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D008404:Massachusetts; D022401:Meningococcal Vaccines / Q000592:standards / Q000627:therapeutic use*; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000592:standards / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D018074:Vaccines, Conjugate / Q000592:standards / Q000627:therapeutic use*
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate