Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Recorded presentation

James A. Gaudino #Epi, MD, MS, MPH¹, Scott Shipman, MD, MPH², Lyle (LJ) Fagnan, MD³, David DeBoer, MS⁴, Heather Angier, BA³, and James Wallace, BA³. (1) Office of Family Health, Immunization Program, Oregon Department of Human Services, 800 NE Oregon Street, Suite 370, Portland, OR 97232, 971-673-0288, James.A.Gaudino@state.or.us, (2) Oregon Rural-based Practice Research Network (ORPRN) and Dept. of Pediatrics, Oregon Health and Sciences University, 707 SW Gaines Rd., Mail code: General Pediatrics, CDRCP, Portland, OR 97239-3098, (3) Oregon Rural-based Practice Research Network (ORPRN) and Department of Family Medicine, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Road, Network, Mail Code L222, Portland, OR 97239-3098, (4) Division of Biostatistics, Department of Public Health & Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098

Little is known about immunization practice barriers among rural Western clinicians. In 2005, we surveyed all 1158 rural Oregon clinicians providing care for <3 year olds by mail or e-mail then priority-mail and telephone. The unadjusted response rate was 58%, with 382 ineligibles and 289 with unknown eligibility. Final respondents (N=424) were medical (58.3%) or osteopathic doctors (9.2%), nurse practitioners (21.6%) and physician assistants (10.9%) practicing family medicine (FM, 81.8%), general practice (GP, 3.3%) and pediatrics (PED, 14.9%). Overall, 38.9% (162) provided immunizations to all, 43.7% (182) to some and 17.5% (73) to no patients. Among those providing “some” vaccines, important referral reasons differed significantly between PEDs versus FM/GPs regarding storage/stocking issues (5.9 vs 34.4%) but not inadequate reimbursement (29.1 vs 45.1%) and documentation hassles (5.6 vs 17.2%). Significantly more vaccinating PEDs than FM/GPs (n=344 total), screened for immunizations during all visits (73.8 vs 52.3%) with fewer total during chronic care (38.0%) and acute illness visits (27.1%). Reasons for not always vaccinating during acute visits included unavailable records (42.0%), degree child delayed (33.0%), and too little time (27.2%). Significantly more PEDs than FM/GPs submitted data to Oregon's ALERT registry (91.8 vs 66.0%), accessed registry data (93.4 vs. 58.7%) and used mail/phone reminders (56.7 vs. 45.4%). Only 40.5% of 215 accessing ALERT used it often. Most agreed computerized systems streamline delivery (82.3%), simplify reminder/recalls (86.8%) and reduce costs (62.0 %). Almost 1/5th of clinicians offer no immunizations, many do not give all vaccines, and, so, patients must rely on referrals.

Learning Objectives:

• Describe rural family medicine and pediatric child immunization practice differences.
• Discuss rural providers’ high immunization referrals. 3)Consider improvement opportunities including registry use.

Keywords: Immunizations, Rural Health Care

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation