A preschool immunization project to enhance immunization levels, the public-private relationship, and continuity of care.

This study was conducted to determine whether implementing a program aimed at providing a variety of incentives to physicians who provide immunizations to preschool-aged children would help to improve immunization rates and reduce fragmented care for patients. Twenty physicians from 14 private practices that provide care to preschool-aged children from low income families in suburban Cook County, Illinois participated in the project. A randomly selected subset of patient case records from the physicians' offices were audited after the implementation of the project to determine the immunization status of children in the practices and the nature of services provided. These 310 records of children under three years of age who were treated between 1991-1994 (the intervention sample) were compared to 310 charts from a 1988-1990 cohort of records (baseline sample). The groups did not differ on race or gender; however, significantly more families in the 1988 through 1990 cohort of children under 3 years of age were insured privately when compared to the 1991 through 1994 cohort. Seventy percent (218) of the records in the intervention sample were up to date for age on immunizations compared to 45% (141) of the baseline records, reflecting a statistically significant difference (p < .00001). The intervention sample showed significantly more well child visits where immunizations were given and follow up visits where immunizations were given when compared to the baseline sample. Physicians completed surveys before and after implementation of the project. They were questioned about their knowledge and practices regarding immunizations as well as their opinion of specific project components. All of the physicians viewed the project as an effective means to improve immunization services to low income children. The project demonstrates a potential means of enhancing immunization levels and continuity of care among preschool-aged children. It also highlights the workable nature of the partnership between public and private sectors.

Immunization practices and beliefs of physicians in suburban Cook County, Illinois.

This study was conducted to ascertain the vaccination beliefs and practices of physicians who provide care for low income children. Sixty-two (56.9%) of a sample of 109 physicians in suburban Cook County, Illinois responded to a mail survey. A majority of physicians reported a willingness to immunize during well child care, follow-up, and chronic illness visits; yet, a substantial lack of willingness to immunize given certain acute mild illnesses was reported. Twenty-six percent of providers did not routinely identify children who were behind in immunizations and only 16% had completed a chart audit in the past three years. Seventy-four percent were willing to provide all shots needed at a single visit. Misconceptions regarding true contraindications was found among the group. Missed well child visits were identified as the greatest barrier to complete immunization. Improvements in vaccination rates are expected if physicians utilize all types of medical encounters to monitor the immunization status of patients and provide vaccines using only true medical contraindications.

Accessibility of cigarettes to minors in suburban Cook County, Illinois.

This study assessed the problem of under age sale of cigarettes, educated vendors about the law restricting the sale of tobacco to minors, and determined the effectiveness of a vendor education intervention. Twenty-one teen volunteers, 14 to 17 years in age, attempted to purchase cigarettes in suburban Cook County from over-the-counter merchants and vending machines. Of the 347 vendors that were checked, the minors were successful in 37.2% of their attempts to purchase cigarettes. After information was sent to each vendor about the State of Illinois law, follow up visits were made to all the vendors who were willing to sell cigarettes to the minors during the first visits. Approximately 50% of the vendors were again willing to sell cigarettes to minors. This study's findings suggest that minors can easily purchase cigarettes in suburban Cook County. The education intervention component of the study had a limited but promising effect on compliance rates of the vendors.