Brief report
Obstetrician–Gynecologists' Practices and Perceived Knowledge Regarding Immunization

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Background

Obstetrician–gynecologists can play a key role in providing appropriate vaccinations to women of childbearing age.

Purpose

This study investigated immunization knowledge and practices, and opinions concerning potential barriers to immunization, among obstetrician-gynecologists.

Methods

In 2007, surveys were sent to Collaborative Ambulatory Research Network members, a representative sample of practicing Fellows of the American College of Obstetricians and Gynecologists; 394 responded (51.2%). Data analysis was completed in 2008.

Results

Most responding obstetrician–gynecologists disagreed that “routine screening for vaccine-preventable diseases falls outside of the routine practice of an ob/gyn.” A majority (78.7%) stock and administer at least some vaccines. Among those who stock vaccines, 91.0% stock the human papillomavirus vaccine, and 66.8% stock the influenza vaccine. All other vaccines were stocked by <30% of practices that stock vaccines. A majority of physicians agreed that financial factors (e.g., inadequate reimbursement) were barriers to vaccine administration. Most were aware that the influenza (89.8%); hepatitis B (64.0%); and tetanus, diptheria, pertussis (58.6%) vaccines are safe to administer during pregnancy, and that the measles, mumps, rubella (97.5%); and varicella (92.9%) vaccines are not. Most (84.5%) were in concordance with recommendations that all pregnant women should receive the influenza vaccine. A majority believed their immunization training was less than adequate and believed their practice would benefit from continuing medical education courses.

Conclusions

Immunization is an important part of women's health care and has been, at least partially, incorporated into obstetrician–gynecologist practice. Financial burdens and knowledge regarding vaccine recommendations remain barriers to vaccine administration. Additional training and professional information may benefit obstetric–gynecologic practice.

Introduction

Vaccines have been a public health success. In the U.S., morbidity for nine diseases for which universal childhood immunization is recommended has decreased by 95%–100%.1 The use of vaccines is not without controversy, however. There are active anti-vaccine movements.2, 3 A notable minority of parents are requesting vaccine exemptions for their children, with public health consequences. A recent upsurge in measles cases in the U.S. occurred predominantly in unvaccinated individuals.4 The incidence of pertussis is highest in states that more easily grant exemptions.5

The CDC has suggested that women of childbearing age should receive a risk assessment of infectious diseases and appropriate vaccinations.6 Obstetrician–gynecologists can and should play a key role in this effort. For example, influenza infections produce a disproportionate morbidity and mortality among pregnant women. Disconcertingly, only 13% of pregnant women received the influenza vaccine in 2003.7 Previous studies8 have shown that obstetrician–gynecologists perceive that providing vaccinations is part of their clinical responsibilities. However, obstetrician–gynecologists do not appear to incorporate immunization into routine patient care; less than half screen patients for vaccination status, and few provide the full complement of vaccines appropriate for pregnant women. Potential barriers include inadequate training in the provision of vaccinations and the costs of obtaining and storing vaccines.9 In this study, an assessment was made of respondents' vaccination practices and knowledge, and potential barriers to providing immunizations.

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Methods

Surveys were designed and pilot-tested within the Department of Obstetrics and Gynecology at the University of Louisville in Kentucky. Survey mailings were sent in June 2007 with up to three reminder mailings, ending in October 2007. Participants were 769 members of the Collaborative Ambulatory Research Network (CARN), practicing members of the American College of Obstetricians and Gynecologists (ACOG). ACOG members make up at least 90% of the practicing obstetricians and gynecologists in the

Demographics

A total of 394 surveys were returned (response rate of 51.2%). There was no evidence of participation bias. Men (50.1%) and women (52.4%) did not differ in their response rates (p=0.527); there was no difference in the year of birth between responders (median=1958) and nonresponders (median=1960; p=0.207). The median age of responders and the proportion of women did not differ across the four mailings; neither did the mean number of vaccinations offered, nor the physicians' opinions regarding

Discussion

These data indicate that a majority of obstetrician–gynecologists provide at least some vaccines in their practice. The HPV and influenza vaccines in particular appear to have become well established (Table 1).

The financial burden of ordering and storing vaccines, as well as inadequate and occasional lack of reimbursement for vaccinations, were perceived as major impediments. A greater proportion of physicians agreed that there was a financial burden to administering vaccines than has been

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