title: Characteristics of Physicians Who Dismiss Families for Refusing Vaccines.
abstract: OBJECTIVE
  Physicians dismissing families who refuse vaccines from their practices is controversial. We assessed the following among pediatricians (Peds) and family physicians (FPs): (1) reported prevalence of parental refusal of 1 or more vaccines in the infant series; (2) physician response to refusal; and (3) the association between often/always dismissing families and provider/practice characteristics and state exemption laws.
  
  
  METHODS
  Nationally representative survey conducted June to October 2012. A multivariable analysis assessed association of often/always dismissing families with physician/practice characteristics, state philosophical exemption policy, and degree of difficulty obtaining nonmedical exemptions.
  
  
  RESULTS
  The response rate was 66% (534/815). Overall, 83% of physicians reported that in a typical month, ≥1% of parents refused 1 or more infant vaccines, and 20% reported that >5% of parents refused. Fifty-one percent reported always/often requiring parents to sign a form if they refused (Peds 64%, FP 29%, P < .0001); 21% of Peds and 4% of FPs reported always/often dismissing families if they refused ≥1 vaccine. Peds only were further analyzed because few FPs dismissed families. Peds who dismissed families were more likely to be in private practice (adjusted odds ratio [aOR] 4.90, 95% confidence interval [CI] 1.40-17.19), from the South (aOR 4.07, 95% CI 1.08-15.31), and reside in a state without a philosophical exemption law (aOR 3.70, 95% CI 1.74-7.85).
  
  
  CONCLUSIONS
  Almost all physicians encounter parents who refuse infant vaccines. One-fifth of Peds report dismissing families who refuse, but there is substantial variation in this practice. Given the frequency of dismissal, the impact of this practice on vaccine refusers and on pediatric practices should be studied.
authors.affiliation: The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; sean.o'leary@childrenscolorado.org.
authors.forename: Sean T
authors.initials: ST
authors.lastname: O'Leary
authors.affiliation: The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Mandy A
authors.initials: MA
authors.lastname: Allison
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Allison
authors.initials: A
authors.lastname: Fisher
authors.affiliation: The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Community and Behavioral Health, Colorado School of Public Health, Denver, Colorado; and.
authors.forename: Lori
authors.initials: L
authors.lastname: Crane
authors.affiliation: The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Brenda
authors.initials: B
authors.lastname: Beaty
authors.affiliation: The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Division of General Internal Medicine, Denver Health, Denver, Colorado.
authors.forename: Laura
authors.initials: L
authors.lastname: Hurley
authors.affiliation: The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Michaela
authors.initials: M
authors.lastname: Brtnikova
authors.affiliation: The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Andrea
authors.initials: A
authors.lastname: Jimenez-Zambrano
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Shannon
authors.initials: S
authors.lastname: Stokley
authors.affiliation: The Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010290:Parents; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*