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Are Immunizations an Incentive for Well-Child Visits?

Nancy Hughart, RN, MPH; Patrick Vivier, MD, PhD; Alan Ross, PhD; Donna Strobino, PhD; Elizabeth Holt, DrPH; William Hou, MS; Bernard Guyer, MD, MPH
Arch Pediatr Adolesc Med. 1997;151(7):690-695. doi:10.1001/archpedi.1997.02170440052009.
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Objective:  To assess the beliefs of parents and the visit patterns of their children to determine whether immunizations act as an incentive to use well-child care.

Design and Methods:  Medical record audits provided data on immunizations and well-child visits. Two questions from a parent interview were used to identify 4 groups of parents: (1) motivated and (2) unmotivated to keep a well-child care appointment regardless of whether immunizations are scheduled, (3) vaccine-motivated and (4) checkup-motivated (parents who were influenced negatively by the prospect of receiving vaccinations). The percentage of children with a visit at each age window for well-child visits and the percentage up-to-date for their immunizations at given ages were compared across the 4 groups. The 4 groups were also compared for other parental attitudes about immunizations and well-child visits, and on sociodemographic and access characteristics.

Results:  Most (73.3%) of the 502 parents surveyed were classified as motivated and 5% as unmotivated to keep a well-child care appointment regardless of whether an immunization was scheduled. Only 18.3% were categorized as vaccine-motivated and 3.4% as checkup-motivated. For all 4 groups, there was no discernible difference in attendance between immunization and non-immunization visits. Attendance in the windows for well-child visits and percentage of children up-to-date on immunizations declined with increasing age.

Conclusions:  In this inner-city population, attendance patterns at visits did not support the incentive hypothesis. This finding should reassure clinicians that providing immunizations outside of regular well-child care visits will not necessarily decrease attendance at visits for well-child care.Arch Pediatr Adolesc Med. 1997;151:690-695


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