To Give or Not to Give: Approaches to Early Childhood Immunization Delivery in Oregon Rural Primary Care Practices

Lyle Fagnan, Scott A. Shipman, James A. Gaudino, Jo Mahler, Andrew L. Sussman, Jennifer Holub

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Context: Little is known about rural clinicians' perspectives regarding early childhood immunization delivery, their adherence to recommended best immunization practices, or the specific barriers they confront. Purpose: To examine immunization practices, beliefs, and barriers among rural primary care clinicians for children in Oregon and compare those who deliver all recommended immunizations in their practices with those who do not. Methods: A mailed questionnaire was sent to all physicians, nurse practitioners, and physician assistants practicing primary care in rural communities throughout Oregon. Findings: While 39% of rural clinicians reported delivering all childhood immunizations in their clinic, 43% of clinicians reported that they refer patients elsewhere for some vaccinations, and 18% provided no immunizations in the clinic whatsoever. Leading reasons for referral include inadequate reimbursement, parental request, and storage and stocking difficulties. Nearly a third of respondents reported that they had some level of concern about the safety of immunizations, and 14% reported that concerns about safety were a specific reason for referring. Clinicians who delivered only some of the recommended immunizations were less likely than nonreferring clinicians to have adopted evidence-based best immunization practices. Conclusions: This study of rural clinicians in Oregon demonstrates the prevalence of barriers to primary care based immunization delivery in rural regions. While some barriers may be difficult to overcome, others may be amenable to educational outreach and support. Thus, efforts to improve population immunization rates should focus on promoting immunization "best practices" and enhancing the capacity of practices to provide immunizations and ensuring that any alternative means of delivering immunizations are effective.

Original languageEnglish (US)
Pages (from-to)385-393
Number of pages9
JournalJournal of Rural Health
Volume27
Issue number4
DOIs
StatePublished - Sep 2011

Fingerprint

Immunization
Primary Health Care
Practice Guidelines
Safety
Physician Assistants
Nurse Practitioners
Rural Population
Vaccination
Referral and Consultation
Physicians

Keywords

  • Child health
  • Health services
  • Immunizations
  • Primary care
  • Rural

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

To Give or Not to Give : Approaches to Early Childhood Immunization Delivery in Oregon Rural Primary Care Practices. / Fagnan, Lyle; Shipman, Scott A.; Gaudino, James A.; Mahler, Jo; Sussman, Andrew L.; Holub, Jennifer.

In: Journal of Rural Health, Vol. 27, No. 4, 09.2011, p. 385-393.

Research output: Contribution to journalArticle

Fagnan, Lyle ; Shipman, Scott A. ; Gaudino, James A. ; Mahler, Jo ; Sussman, Andrew L. ; Holub, Jennifer. / To Give or Not to Give : Approaches to Early Childhood Immunization Delivery in Oregon Rural Primary Care Practices. In: Journal of Rural Health. 2011 ; Vol. 27, No. 4. pp. 385-393.
@article{f2e3885409244d35ba5fad0da8a65d43,
title = "To Give or Not to Give: Approaches to Early Childhood Immunization Delivery in Oregon Rural Primary Care Practices",
abstract = "Context: Little is known about rural clinicians' perspectives regarding early childhood immunization delivery, their adherence to recommended best immunization practices, or the specific barriers they confront. Purpose: To examine immunization practices, beliefs, and barriers among rural primary care clinicians for children in Oregon and compare those who deliver all recommended immunizations in their practices with those who do not. Methods: A mailed questionnaire was sent to all physicians, nurse practitioners, and physician assistants practicing primary care in rural communities throughout Oregon. Findings: While 39{\%} of rural clinicians reported delivering all childhood immunizations in their clinic, 43{\%} of clinicians reported that they refer patients elsewhere for some vaccinations, and 18{\%} provided no immunizations in the clinic whatsoever. Leading reasons for referral include inadequate reimbursement, parental request, and storage and stocking difficulties. Nearly a third of respondents reported that they had some level of concern about the safety of immunizations, and 14{\%} reported that concerns about safety were a specific reason for referring. Clinicians who delivered only some of the recommended immunizations were less likely than nonreferring clinicians to have adopted evidence-based best immunization practices. Conclusions: This study of rural clinicians in Oregon demonstrates the prevalence of barriers to primary care based immunization delivery in rural regions. While some barriers may be difficult to overcome, others may be amenable to educational outreach and support. Thus, efforts to improve population immunization rates should focus on promoting immunization {"}best practices{"} and enhancing the capacity of practices to provide immunizations and ensuring that any alternative means of delivering immunizations are effective.",
keywords = "Child health, Health services, Immunizations, Primary care, Rural",
author = "Lyle Fagnan and Shipman, {Scott A.} and Gaudino, {James A.} and Jo Mahler and Sussman, {Andrew L.} and Jennifer Holub",
year = "2011",
month = "9",
doi = "10.1111/j.1748-0361.2010.00356.x",
language = "English (US)",
volume = "27",
pages = "385--393",
journal = "Journal of Rural Health",
issn = "0890-765X",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - To Give or Not to Give

T2 - Approaches to Early Childhood Immunization Delivery in Oregon Rural Primary Care Practices

AU - Fagnan, Lyle

AU - Shipman, Scott A.

AU - Gaudino, James A.

AU - Mahler, Jo

AU - Sussman, Andrew L.

AU - Holub, Jennifer

PY - 2011/9

Y1 - 2011/9

N2 - Context: Little is known about rural clinicians' perspectives regarding early childhood immunization delivery, their adherence to recommended best immunization practices, or the specific barriers they confront. Purpose: To examine immunization practices, beliefs, and barriers among rural primary care clinicians for children in Oregon and compare those who deliver all recommended immunizations in their practices with those who do not. Methods: A mailed questionnaire was sent to all physicians, nurse practitioners, and physician assistants practicing primary care in rural communities throughout Oregon. Findings: While 39% of rural clinicians reported delivering all childhood immunizations in their clinic, 43% of clinicians reported that they refer patients elsewhere for some vaccinations, and 18% provided no immunizations in the clinic whatsoever. Leading reasons for referral include inadequate reimbursement, parental request, and storage and stocking difficulties. Nearly a third of respondents reported that they had some level of concern about the safety of immunizations, and 14% reported that concerns about safety were a specific reason for referring. Clinicians who delivered only some of the recommended immunizations were less likely than nonreferring clinicians to have adopted evidence-based best immunization practices. Conclusions: This study of rural clinicians in Oregon demonstrates the prevalence of barriers to primary care based immunization delivery in rural regions. While some barriers may be difficult to overcome, others may be amenable to educational outreach and support. Thus, efforts to improve population immunization rates should focus on promoting immunization "best practices" and enhancing the capacity of practices to provide immunizations and ensuring that any alternative means of delivering immunizations are effective.

AB - Context: Little is known about rural clinicians' perspectives regarding early childhood immunization delivery, their adherence to recommended best immunization practices, or the specific barriers they confront. Purpose: To examine immunization practices, beliefs, and barriers among rural primary care clinicians for children in Oregon and compare those who deliver all recommended immunizations in their practices with those who do not. Methods: A mailed questionnaire was sent to all physicians, nurse practitioners, and physician assistants practicing primary care in rural communities throughout Oregon. Findings: While 39% of rural clinicians reported delivering all childhood immunizations in their clinic, 43% of clinicians reported that they refer patients elsewhere for some vaccinations, and 18% provided no immunizations in the clinic whatsoever. Leading reasons for referral include inadequate reimbursement, parental request, and storage and stocking difficulties. Nearly a third of respondents reported that they had some level of concern about the safety of immunizations, and 14% reported that concerns about safety were a specific reason for referring. Clinicians who delivered only some of the recommended immunizations were less likely than nonreferring clinicians to have adopted evidence-based best immunization practices. Conclusions: This study of rural clinicians in Oregon demonstrates the prevalence of barriers to primary care based immunization delivery in rural regions. While some barriers may be difficult to overcome, others may be amenable to educational outreach and support. Thus, efforts to improve population immunization rates should focus on promoting immunization "best practices" and enhancing the capacity of practices to provide immunizations and ensuring that any alternative means of delivering immunizations are effective.

KW - Child health

KW - Health services

KW - Immunizations

KW - Primary care

KW - Rural

UR - http://www.scopus.com/inward/record.url?scp=80053471842&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053471842&partnerID=8YFLogxK

U2 - 10.1111/j.1748-0361.2010.00356.x

DO - 10.1111/j.1748-0361.2010.00356.x

M3 - Article

C2 - 21967382

AN - SCOPUS:80053471842

VL - 27

SP - 385

EP - 393

JO - Journal of Rural Health

JF - Journal of Rural Health

SN - 0890-765X

IS - 4

ER -