Washington State Licensed Child Care Facility Directors' Perspectives on Childhood Immunization.

BACKGROUND: The study objective was to determine Washington State childcare facility directors' compliance with state immunization education and monitoring requirements and the role of directors' immunization attitudes and beliefs on compliance. METHODS: We mailed a self-administered survey to 2000 randomly selected childcare facility directors in Washington State. The primary outcome measures were reported compliance with state requirements to educate parents about the importance of immunizations and monitor the immunization status of enrolled children. RESULTS: Our response rate was 28%. The majority of respondents worked at facilities with a licensed capacity of <25 children, had ≥11 years of experience, and were parents themselves. Overall, 68% agreed that they educated enrolled parents about the importance of immunizations and 90% agreed that they monitored the immunization status of enrolled children. However, 60% were concerned that children might have a serious side effect from an immunization, 51% were concerned that any one of the childhood immunizations might not be safe, and 11% were distrustful of the immunization information they received. These beliefs were associated with a statistically significant decreased likelihood of educating parents about immunization (adjusted odds ratios [aORs]: 0.57, 0.46, 0.19, respectively) and monitoring immunization status of children (aORs: 0.32, 0.32, 0.19, respectively). CONCLUSIONS: Most Washington State child care facility directors who responded to our survey are compliant with state requirements for immunization education and monitoring. A substantial number of directors are concerned about vaccine safety, however, and these concerns may decrease the likelihood of these requirements being followed.

Effectiveness of a physician peer educator in improving the quality of immunization services for young children in primary care practices.

OBJECTIVE: To determine if the addition of a physician peer educator would lead to improved immunization quality when compared to the traditional education provided as part of a vaccines for children (VFC) site visit. METHODS: A randomized controlled trial was conducted. Study participants were private pediatric and family medicine practices. Both the intervention and control groups received a VFC visit; in intervention practices this visit was augmented by a presentation by the physician peer educator. Data on immunization rates and quality of immunization services were collected prior to the VFC visits and approximately 1 year later. RESULTS: A total of 73 practices participated, including 37 in the intervention group and 36 in the control group. At follow-up there was no difference in practice immunization rates (PIR) between intervention and control practices (mean rates 71.4% and 69.6%, respectively, P=0.94). There were also no significant differences between groups for any of the quality measures except that significantly more intervention practices used the appropriate length needle for vaccine injections in 2-month-old infants at follow-up (P=0.02). When assessing the overall impact of VFC visits, no significant increase in PIR were noted from baseline to follow-up assessments. However, statistically significant improvements in several quality measures were found. CONCLUSIONS: The addition of a physician peer educator did not result in improved immunization quality when compared to VFC visits alone. The educational content of the VFC site visit was associated with improved quality of immunization services delivered by primary care practices.

Immunization information systems.

The American Academy of Pediatrics continues to support the development and implementation of immunization information systems, previously referred to as immunization registries, and other systems for the benefit of children, pediatricians, and their communities. Pediatricians and others must be aware of the value that immunization information systems have for society, the potential fiscal influences on their practice, the costs and benefits, and areas for future improvement.