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One-Year Uptake of Pneumococcal Conjugate Vaccine: A National Survey of Family Physicians and Pediatricians

Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics (MMD, GLF, SJC), Ann Arbor
Division of General Internal Medicine (MMD), University of Michigan, Ann Arbor
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia (SMN)

Correspondence: Address correspondence to Matthew M. Davis, MD, MAPP, University of Michigan, 300 NIB, 6C23, Ann Arbor, MI 48109-0456 (e-mail: mattdav{at}umich.edu)

Background: Pneumococcal conjugate vaccine (PCV7) was recommended by June 2000 for administration to all US children 23 months old and to children at high risk for pneumococcal disease 24 to 59 months old. We sought to identify physician characteristics associated with adoption of the recommendation within 1 year.

Methods: We conducted a cross-sectional mail survey from April to July, 2001, of 788 family physicians (FP) and 833 pediatricians (PD) in 24 states. We measured whether physicians had adopted PCV7 recommendations, their expectations of the effectiveness of PCV7, the number of vaccine injections they would consider administering at 1 visit, and barriers to administering multiple injections.

Results: Response rate was 60%. Overall, 87% of physicians had adopted PCV7 recommendations (68% FP; 99% PD; P < .001). FP adopters are significantly more likely than nonadopters to believe PCV7 will be effective in preventing pneumococcal sepsis and meningitis, as well as >25% of cases of otitis media. In multivariable logistic regression analyses of adoption of PCV7, FP who have higher proportions of African American patients and patients on Medicaid, see greater numbers of newborns, work in practices of 4 physicians, and are willing to consider administering at least 4 vaccine injections at 1 visit are significantly more likely to have adopted PCV7. Concerns about vaccine cost and reimbursement were the most commonly cited factors in physicians’ decisions not to adopt PCV7 recommendations.

Conclusions: One year after PCV7 was recommended, nearly all pediatricians and a majority of family physicians had incorporated this vaccine into their practices. Barriers to higher rates of uptake—especially among family physicians—must be addressed to achieve immunization goals with this new vaccine.

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