Practices of Family Physicians and Pediatricians in Administering Poliovirus Vaccine

,

Original Research

Practices of Family Physicians and Pediatricians in Administering Poliovirus Vaccine

J Fam Pract. 1999 August;48(8):594-600

References

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Results

Three hundred nine physicians responded to the survey: 147 family physicians and 162 pediatricians. This represents a total response rate of 57.5% (65% for family physicians and 50% for pediatricians). Two hundred sixty-three (85%) of the responding physicians reported that they provide immunizations for children, 121 family physicians (46%) and 142 pediatricians (54%) Table 1. Physician groups were similar across all demographic characteristics with the exception that more pediatricians were women and in hospital-based practice; more family physicians were in solo or 2-physician practices; and family physicians’ practices were more likely to be located in less-populated communities. This sample closely approximates the national demographic data reported for family physicians by the AAFP¹⁸ and for pediatricians by the AAP.¹⁹

Awareness of the 1997 Poliovirus Vaccine Recommendations

Ninety-eight percent of the physicians reported that they followed a standardized protocol provided by the CDC, AAP, or AAFP for the administration of immunizations. All physicians reported that they were aware of 1997 recommendations for the administration of PVV. Ninety-three (77%) of the family physicians reported that they were aware of the 1997 AAFP PVV recommendations. One hundred forty (99%) of the pediatricians reported that they were aware of the 1997 AAP PVV recommendations. Family physicians (56%) were less likely than pediatricians (71%) to be aware of the 1997 CDC recommendations (c2 = 18.9, P = .000).

Most Frequently Recommended Poliovirus Vaccine Schedule

One hundred thirty-one physicians (50%) reported that they most frequently recommend the sequential schedule for the administration of PVV to parents or caregivers; 84 (32%) usually recommend all OPV; and 3 (1%) usually recommend all IPV. Only 28 (11%) usually recommend all of the above. Eight (3%) indicated they recommend something other than those options indicated (usually the physician wrote in that they do not make a recommendation, rather it is the parent’s choice); and 9 (3%) did not answer the question Figure 1.

Most Frequently Administered Vaccine Schedule

One hundred twenty-nine physicians (49%) reported that they most frequently administer the sequential vaccine; 115 (44%) most frequently administer all OPV; 6 (2%) most frequently administer all IPV; 8 (3%) indicated they most frequently administer something other than those options; and 5 (2%) did not answer the question Figure 2.

How Physicians Discuss Vaccine Options with Parents or Caregivers

Physicians were asked how they make recommendations for administering poliovirus vaccine to the parent or caregiver Figure 3. More than 1 option could be selected. One hundred eighty-two (69%) indicated that they personally discuss these options with the parent or caregiver; 57 (22%) indicated that their office nurse or medical assistant discusses each option; and 109 (41%) report that the parent or caregiver reads handouts provided by the AAP or CDC vaccine information sheets that describe these options to parents and caregivers.

Pediatricians were more likely than family physicians to have parents read an information sheet (c2 = 6.23; P = .013).

Factors that Influence Physician Practice in the Administration of Poliovirus Vaccine

Factors that physicians indicated influence their actual administration of PVV are displayed in Table 2. All factors were entered into a logistic regression model to assess their independent effect on physician administration of the sequential PVV schedule versus the all OPV schedule. Factors were entered simultaneously using stepwise regression analyses designed to maximize prediction of those factors most likely to influence the actual administration practices of physicians. The resulting models included only those factors significant at a ·.05. Factors that influence physicians who choose to administer the sequential PVV included liability concerns and risk of VAPP. Factors that influence physicians who choose the all OPV schedule included cost of IPV and increased number of injections Table 3.

Discussion

All survey respondents indicated that they were familiar with at least 1 of the poliovirus vaccination recommendations from the AAFP, the AAP, or the CDC. At the time our study was conducted, both the AAFP and AAP recommended that parents be offered a choice from all 3 schedules following an explanation of the risks and benefits. The ACIP recommended the sequential schedule but stated that the others were acceptable options.¹ The vast majority of physicians in our study indicated that they followed 1 or more of the protocols recommended by the 3 organizations. Family physicians were less likely than pediatricians to be familiar with the ACIP recommendations.

Timely dissemination of vaccine information may contribute to pediatricians’ greater awareness of the ACIP recommendations. The AAP sends out a member alert regarding new vaccines months before the recommendations are actually published in Pediatrics. In addition, these recommendations are published in the newsletter AAP News. The AAFP publishes the Recommended Childhood Immunization Schedule in American Family Physician as soon as it is available for that purpose. However, the AAFP does not currently publish this information in its newsletter AAFP Report, and it does not provide a member alert regarding immunization issues.