Dr Rodewald and colleagues1 presented an interesting study of the correlation between several components of pediatric preventive health care. However, the accompanying editor's note by Dr DeAngelis extrapolated their findings to a suggestion to withhold immunizations in the acute care emergency department (ED) setting so as to avoid providing incomplete health maintenance services. I would like to examine this a little further.
If providing immunizations in certain settings decreased the utilization of other recognized preventive measures, then this would clearly be less desirable than providing comprehensive primary care. This raises several points. First, is comprehensive primary care available and accessible? Second, would receipt of immunizations in the ED decrease the use of regular primary care? Or are other factors (health insurance status, education level, transportation, or stressors related to socioeconomic status) more closely related to the use or nonuse of primary care? Is urgent or emergency care the main