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December 1997, Vol 151, No. 12 >
Article | December 1997

Effect of the Vaccines for Children Program on Inner-city Neighborhood Physicians FREE

Gerry Fairbrother, PhD; Stephen Friedman, MD, MPH; Karla L. Hanson, PhD; Gary C. Butts, MD
[+] Author Affiliations

The affiliations of the authors appear in the acknowledgment section at the end of the article.


Arch Pediatr Adolesc Med. 1997;151(12):1229-1235. doi:10.1001/archpedi.1997.02170490055010.
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Objective:  To determine the probable effect of the Vaccines for Children (VFC) program on immunization coverage.

Design:  Preintervention and postintervention study design, with data collected before and after enrollment in the VFC program.

Setting:  Twenty-three inner-city neighborhood physicians' offices in New York City.

Participants:  In 1993,30 physicians were randomly selected from 8 neighborhoods with the highest proportions of Medicaid-eligible individuals in New York City. In 1995-1996, the 30 physicians were contacted again. Twenty-three agreed to an interview and medical record review. Within each office, the medical records of children aged 3 to 35 months, with at least 3 visits in a 3-month or longer period, were randomly selected. Medical record reviews were conducted for 173 eligible children in 1993 and 528 in 1995-1996.

Interventions:  The VFC program was implemented in October 1994. The administration fee increased from $2 to $17.85; physicians received vaccines free.

Main Outcome Measures:  Up-to-date status for immunizations and lead and tuberculosis screening; percentage of visits that are missed opportunities to immunize; and percentage of visits that were well-child visits. Up-to-date status, missed opportunities to immunize, and well-child visits were compared across time using χ2 analysis, corrected for the use of cluster sampling.

Results:  Up-to-date status changed significantly before and after enrollment in the VFC program (P<.05) for all immunizations and for lead and tuberculosis screening. For the diphtheria toxoid, tetanus toxoid, and pertussis vaccine, oral poliovirus vaccine, and measles, mumps, and rubella vaccine combined, coverage increased from 17.9% to 42.2%, up by 24.3 percentage points (P<.05). Missed opportunities to immunize did not change, but well-child visits increased from 15.0% to 21.6% (P<.05). Physicians generally attributed performance improvements to the VFC program and not to other competing hypotheses.

Conclusions:  The VFC program seems to be responsible for an increase in immunization rates among these physicians.Arch Pediatr Adolesc Med. 1997;151:1229-1235.

REFERENCES

1 +
Robinson CA, Evans WB, Mahanes JA, Sepe SJ.  Progress on the Childhood Immunization Initiative . Public Health Rep . 1994;;109:594-600.
2 +
Centers for Disease Control and Prevention.  Recommendations for the use of varicella virus vaccine . MMWR Morb Mortal Wkly Rep . 1996;;45(RR-11 ):12-24.
3 +
Centers for Disease Control and Prevention.  Recommendations for use of hepatitis A vaccine and immune globulin . MMWR Morb Mortal Wkly Rep . 1996;;45 (RR-15):21-25.
4 +
Ruch-Ross HS, O'Connor KG.  Immunization referral practices of pediatricians in the United States . Pediatrics . 1994;;94:503-513.
5 +
Bordley WC, Freed GL, Garrett JM, Byrd CA, Meriwether R.  Factors responsible for immunization referrals to health departments in North Carolina . Pediatrics . 1994;;94:376-380.
6 +
Lieu TA, Smith MD, Newacheck PW, Langthorn D, Venkatesh P, Herradora R.  Health insurance and preventive care sources of children at public immunization clinics . Pediatrics . 1994;;93:373-378.
7 +
Schulte JM, Bown GR, Zetman MR, et al.  Changing immunization referral patterns among pediatricians and family practice physicians, Dallas County, Texas, 1988 . Pediatrics . 1991;:87:204-207.
8 +
Centers for Disease Control and Prevention.  Physician vaccination referral practices and vaccines for children . MMWR Morb Mortal Wkly Rep . 1994;;44:3-6.
9 +
Hueston WJ, Mainous AG, Farrell JB.  Childhood immunization availability in primary care practices: effects of programs providing free vaccines to physicians . Arch Fam Med . 1994;;3:605-609.
10 +
Zimmerman RK, Medsger AR, Ricci EM, Raymund M, Mieczkowski TA, Grufferman S. Impact of free vaccine and insurance status on physician referral of children to public vaccine clinics. JAMA. In press.
11 +
Wood DL, Halfon N.  The impact of the Vaccine for Children's program on child immunization delivery: a policy analysis . Arch Pediatr Adolesc Med . 1996;:150: 577-581.
12 +
Saldarini RJ.  Putting prevention research at risk: implementation of the Vaccines for Children program . Vaccine . 1994;;12:1364-1367.
13 +
Marwick C.  Vaccines for Children program off and running . JAMA . 1994;:272: 1156-1157.
14 +
New York State Department of Social Services. Medicaid Management Information System Provider Manual . Albany: New York State Department of Social Services; 1993;:7-80.
15 +
New York State Department of Social Services. Medicaid Update . Albany: New York State Department of Social Services; 1994;:5.
16 +
Fairbrother G, Friedman S, DuMont DA, Lobach KS.  Markers for primary care: missed opportunities to immunize and screen for lead and tuberculosis by private physicians serving large numbers of inner-city Medicaid-eligible children . Pediatrics . 1996;;97:785-790.
17 +
New York City Community Health Atlas . New York, NY: United Hospital Fund; 1994;:166.
18 +
Centers for Disease Control and Prevention. Guidelines for Assessing Vaccination Levels of the 2-Year-Old Population in a Clinic Setting . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1992;.
19 +
New York City Department of Health, Bureau of Tuberculosis Control. Prevention and Control of Pediatric Tuberculosis in New York City: Recommendations of the Expert Advisory Panel . New York, NY: New York City Department of Health; 1995;.
20 +
Committee on Nutrition, American Academy of Pediatrics. Pediatric Nutrition Handbook . 3rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1993;.
21 +
Centers for Disease Control and Prevention. Preventing Lead Poisoning in Young Children . Atlanta, Ga: Centers for Disease Control and Prevention; 1991;.
22 +
Lee ES, Forthofer RN, Lorimor RN. Analyzing Complex Survey Data . Newbury Park, Calif: Sage University Press; 1989;.
23 +
New York City Department of Health, Bureau of Immunization. Retrospective School Entrant Survey for School Years 1994-1996 . New York, NY: New York City Dept of Health, Bureau of Immunization; 1996;.
24 +
Centers for Disease Control and Prevention.  National, state, and urban vaccination coverage levels among children 19-35 months—United States, April, 1994-March, 1995 . MMWR Morb Mortal Wkly Rep . 1996;;45:149.
25 +
United Hospital Fund.  Medicaid managed care . Currents . Fall 1996;;1:1.
26 +
Rodewald LE, Szilagyi PG, Shiuh T, et al.  Is underimmunization a marker for insufficient utilization of preventive and primary care? Arch Pediatr Adolesc Med . 1995;;149:393-397.
27 +
Adams W, Coffman G, Palfrey S.  Anemia and plumbism in underimmunized children . Arch Pediatr Adolesc Med . 1996;:150:77.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Robinson CA, Evans WB, Mahanes JA, Sepe SJ.  Progress on the Childhood Immunization Initiative . Public Health Rep . 1994;;109:594-600.
2 +
Centers for Disease Control and Prevention.  Recommendations for the use of varicella virus vaccine . MMWR Morb Mortal Wkly Rep . 1996;;45(RR-11 ):12-24.
3 +
Centers for Disease Control and Prevention.  Recommendations for use of hepatitis A vaccine and immune globulin . MMWR Morb Mortal Wkly Rep . 1996;;45 (RR-15):21-25.
4 +
Ruch-Ross HS, O'Connor KG.  Immunization referral practices of pediatricians in the United States . Pediatrics . 1994;;94:503-513.
5 +
Bordley WC, Freed GL, Garrett JM, Byrd CA, Meriwether R.  Factors responsible for immunization referrals to health departments in North Carolina . Pediatrics . 1994;;94:376-380.
6 +
Lieu TA, Smith MD, Newacheck PW, Langthorn D, Venkatesh P, Herradora R.  Health insurance and preventive care sources of children at public immunization clinics . Pediatrics . 1994;;93:373-378.
7 +
Schulte JM, Bown GR, Zetman MR, et al.  Changing immunization referral patterns among pediatricians and family practice physicians, Dallas County, Texas, 1988 . Pediatrics . 1991;:87:204-207.
8 +
Centers for Disease Control and Prevention.  Physician vaccination referral practices and vaccines for children . MMWR Morb Mortal Wkly Rep . 1994;;44:3-6.
9 +
Hueston WJ, Mainous AG, Farrell JB.  Childhood immunization availability in primary care practices: effects of programs providing free vaccines to physicians . Arch Fam Med . 1994;;3:605-609.
10 +
Zimmerman RK, Medsger AR, Ricci EM, Raymund M, Mieczkowski TA, Grufferman S. Impact of free vaccine and insurance status on physician referral of children to public vaccine clinics. JAMA. In press.
11 +
Wood DL, Halfon N.  The impact of the Vaccine for Children's program on child immunization delivery: a policy analysis . Arch Pediatr Adolesc Med . 1996;:150: 577-581.
12 +
Saldarini RJ.  Putting prevention research at risk: implementation of the Vaccines for Children program . Vaccine . 1994;;12:1364-1367.
13 +
Marwick C.  Vaccines for Children program off and running . JAMA . 1994;:272: 1156-1157.
14 +
New York State Department of Social Services. Medicaid Management Information System Provider Manual . Albany: New York State Department of Social Services; 1993;:7-80.
15 +
New York State Department of Social Services. Medicaid Update . Albany: New York State Department of Social Services; 1994;:5.
16 +
Fairbrother G, Friedman S, DuMont DA, Lobach KS.  Markers for primary care: missed opportunities to immunize and screen for lead and tuberculosis by private physicians serving large numbers of inner-city Medicaid-eligible children . Pediatrics . 1996;;97:785-790.
17 +
New York City Community Health Atlas . New York, NY: United Hospital Fund; 1994;:166.
18 +
Centers for Disease Control and Prevention. Guidelines for Assessing Vaccination Levels of the 2-Year-Old Population in a Clinic Setting . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1992;.
19 +
New York City Department of Health, Bureau of Tuberculosis Control. Prevention and Control of Pediatric Tuberculosis in New York City: Recommendations of the Expert Advisory Panel . New York, NY: New York City Department of Health; 1995;.
20 +
Committee on Nutrition, American Academy of Pediatrics. Pediatric Nutrition Handbook . 3rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1993;.
21 +
Centers for Disease Control and Prevention. Preventing Lead Poisoning in Young Children . Atlanta, Ga: Centers for Disease Control and Prevention; 1991;.
22 +
Lee ES, Forthofer RN, Lorimor RN. Analyzing Complex Survey Data . Newbury Park, Calif: Sage University Press; 1989;.
23 +
New York City Department of Health, Bureau of Immunization. Retrospective School Entrant Survey for School Years 1994-1996 . New York, NY: New York City Dept of Health, Bureau of Immunization; 1996;.
24 +
Centers for Disease Control and Prevention.  National, state, and urban vaccination coverage levels among children 19-35 months—United States, April, 1994-March, 1995 . MMWR Morb Mortal Wkly Rep . 1996;;45:149.
25 +
United Hospital Fund.  Medicaid managed care . Currents . Fall 1996;;1:1.
26 +
Rodewald LE, Szilagyi PG, Shiuh T, et al.  Is underimmunization a marker for insufficient utilization of preventive and primary care? Arch Pediatr Adolesc Med . 1995;;149:393-397.
27 +
Adams W, Coffman G, Palfrey S.  Anemia and plumbism in underimmunized children . Arch Pediatr Adolesc Med . 1996;:150:77.

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