Physician response to parental requests to spread out the recommended vaccine schedule.
OBJECTIVE
To assess among US physicians (1) frequency of requests to spread out recommended vaccination schedule for children <2 years, (2) attitudes regarding such requests, and (3) strategies used and perceived effectiveness in response to such requests.


METHODS
An e-mail and mail survey of a nationally representative sample of pediatricians and family physicians from June 2012 through October 2012.


RESULTS
The response rate was 66% (534 of 815). In a typical month, 93% reported some parents of children <2 years requested to spread out vaccines; 21% reported ≥ 10% of parents made this request. Most respondents thought these parents were putting their children at risk for disease (87%) and that it was more painful for children (84%), but if they agreed to requests, it would build trust with families (82%); further, they believed that if they did not agree, families might leave their practice (80%). Forty percent reported this issue had decreased their job satisfaction. Most agreed to spread out vaccines when requested, either often/always (37%) or sometimes (37%); 2% would often/always, 4% would sometimes, and 12% would rarely dismiss families from their practice if they wanted to spread out the primary series. Physicians reported using a variety of strategies in response to requests but did not think they were effective.


CONCLUSIONS
Virtually all providers encounter requests to spread out vaccines in a typical month and, despite concerns, most are agreeing to do so. Providers are using many strategies in response but think few are effective. Evidence-based interventions to increase timely immunization are needed to guide primary care and public health practice.
Children's Outcomes Research, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado; allison.kempe@childrenscolorado.org.
Allison
A
Kempe
Children's Outcomes Research, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado;
Sean T
ST
O'Leary
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
Allison
A
Kennedy
Children's Outcomes Research, Children's Hospital Colorado, Aurora, Colorado; Department of Community and Behavioral Health, Colorado School of Public Health, Denver, Colorado; and.
Lori A
LA
Crane
Children's Outcomes Research, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado;
Mandy A
MA
Allison
Children's Outcomes Research, Children's Hospital Colorado, Aurora, Colorado;
Brenda L
BL
Beaty
Children's Outcomes Research, Children's Hospital Colorado, Aurora, Colorado; Division of General Internal Medicine, Denver Health, Denver, Colorado.
Laura P
LP
Hurley
Children's Outcomes Research, Children's Hospital Colorado, Aurora, Colorado;
Michaela
M
Brtnikova
Children's Outcomes Research, Children's Hospital Colorado, Aurora, Colorado;
Andrea
A
Jimenez-Zambrano
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
Shannon
S
Stokley
D000328:Adult; D001291:Attitude of Health Personnel; D002675:Child, Preschool; D005194:Family Practice; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations; D018570:Risk Assessment
immunizations; provider survey; risk and benefit communication; vaccine hesitancy; vaccine refusal