We are writing in regard to the article by Zimmerman et al, "A National Survey to Understand Why Physicians Defer Childhood Immunizations."1 In a similar survey performed at Raymond Blank Memorial Hospital for Children in Des Moines, Iowa, we found somewhat similar results.
The purpose of our study was to determine the closeness with which recommended immunization guidelines2 were followed by Iowa physicians. A questionnaire, "Childhood Immunization Practices Survey," was sent to all general practitioners, family practice specialists, and pediatricians licensed in the state of Iowa. Physician respondents were characterized by specialty, years of practice, population of community where practice was located, and number of physicians in the practice group. The relationship of 3 of these variables (specialty, years of practice, and community size) to immunization practices was then investigated. Each community size (<5000, 5000-14999, 15000-49999, and ≥50000) was uniformly represented in this survey. A smaller proportion of the general practitioners (55.5%) had been in practice for fewer than 20 years compared with physicians who specialized in family practice (77%) or pediatrics (88.9%) (P<.11). On average, the physicians who responded to the survey had been in practice for 16 years. Physicians who had been in practice the longest were located in smaller communities. Nearly 50% of the physicians indicated that they were in a group practice of more than 3 physicians, with the remaining respondents evenly divided between solo practice (25%) and a group of 2 or 3 physicians (26%). The explanation of immunizations to the patient or parents or guardians was given most frequently by the physician (71%), followed by a registered nurse (59%), nurse assistant (27%), physician assistant (12%), and medical student (2.3%). Three fourths of the respondents indicated that more than 75% of the 2-year-olds in their practices were up to date with their immunizations. Twenty-five percent of the physicians indicated that they administered vaccines to children with a minor illness accompanied by fever, while 88% immunized mildly ill children who did not have fever. These practices were unrelated to specialization or years of practice.