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A 'Barrier-Free' Health Care System Does Not Ensure Adequate Vaccination of 2-Year-Old Children

Coleen Baird Weese, MD, MPH; Margot R. Krauss, MD, MPH
Arch Pediatr Adolesc Med. 1995;149(10):1130-1135. doi:10.1001/archpedi.1995.02170230084012.
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Objectives:  To assess vaccination status in a cohort of 2 year olds with access to health care at no cost and to delineate factors associated with failure to be fully vaccinated.

Design:  Retrospective cross-sectional study. Children not up-to-date on vaccinations by age 2 years compared with children up-to-date by medical record review. A telephone survey was conducted for those without medical records or whose records lacked complete documentation.

Setting:  Large military tertiary care hospital.

Participants:  A cohort of 844 children born between August 31, 1988, and September 1, 1989.

Main Outcome Measures:  Timeliness of vaccination, factors associated with undervaccination, number and nature of missed opportunities.

Results:  Best estimate of coverage with entire primary vaccination series was 72% by age 2 years. Attendance at military day care was associated with full vaccination (odds ratio [OR]=1.80, confidence interval [CI] =1.12 to 3.24) as was completion of well-baby visits. Increasing number of other visits did not predict full vaccination. Children followed up by family practice were more likely to be up-to-date than children followed up by pediatrics (OR=3.67, CI=1.47 to 9.73). Seventy-two percent of children who were not up-to-date had at least one missed opportunity for vaccination. If vaccinations had been offered at all visits, 93% of children could have been fully vaccinated by age 2 years.

Conclusions:  Offering free vaccinations in a "barrierfree" system will not ensure vaccination levels of 90%. Health care providers should offer vaccinations during acute, non-well visits to improve coverage.(Arch Pediatr Adolesc Med. 1995;149:1130-1135)


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