Vaccines Provided by Family Physicians

Doug Campos-Outcalt; Michelle Jeffcott-Pera; Pamela Carter-Smith; Bellinda K. Schoof; Herbert F. Young

doi:10.1370/afm.1185

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Table 1.

Demographic Characteristics of Respondents Compared With Active AAFP Members

Demographic Characteristic	Respondents (N=637)	Active AAFP Members (N=24,794)
AAFP = American Academy of Family Physicians.
Note: percentages do not always add to 100 because of occasional missing values for the specific variable.
Female, %	33.3	31.5
Male, %	66.7	68.5
Age, mean (SD), y	49.8 (9.8)	49.4 (8.9)
In solo practice, %	27.1	20.4
In 2-person group, %	7.9	9.4
In family physician group, %	45.5	44.5
In multispecialty group, %	19.5	25.7

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Table 2.

Percentage of Respondents Routinely Providing Child and Adolescent Vaccines On Site, Referring Elsewhere, or Neither Providing nor Referring for Specific Vaccines (n = 582)

Vaccine	Provide in Practice	Sometimes or Always Refer	Neither Give nor Refer
DTaP = Diphtheria and tetanus toxoids and acellular pertussis; MMR = measles-mumps-rubella; Tdap = tetanus toxoid and reduced-strength diphtheria toxoid and acellular pertussis.
Note: row totals may add to more than 100% because respondents may have checked, for example, that they provide a vaccine in their practice, as well as that they sometimes refer it.
^a Did not specify between conjugate meningococcal vaccine and polysaccharide meningococcal vaccine.
DTaP	88.7	11.0	3.8^a
Haemophilus influenzae type b	80.6	16.0	6.0
Hepatitis A virus	79.6	18.0	5.5
Hepatitis B virus	90.1	10.6	3.4
Human papillomavirus	83.9	15.6	4.5
Inactivated poliovirus	79.2	16.6	6.5
Influenza	93.8	6.3	2.9
MMR	84.9	13.6	4.5
Neisseria meningitidis^a	79.6	20.2	4.5
Pneumococcal	94.2	5.3	2.9
Pneumococcal polysaccharide vaccine	82.5	14.9	6.0
Rotavirus	45.5	33.8	22.0
Tdap	90.6	9.8	3.1
Varicella	81.6	17.0	5.0

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Table 3.

Percentage of Respondents Routinely Providing Adult Vaccines On Site (n = 612)

Vaccine	Providing On Site
MMR=measles-mumps-rubella; Td=tetanus toxoid/reduced-strength diphtheria toxoid; Tdap = tetanus toxoid/reduced-strength diphtheria toxoid and acellular pertussis.
^a Did not specify meningococcal conjugate vaccine or meningococcal polysaccharide vaccine.
Hepatitis A virus	65.3
Hepatitis A and B combination	30.6
Hepatitis B virus	83.6
Human papillomavirus	77.4
Influenza	91.9
MMR	73.0
Meningococcal^a	70.5
Pneumococcal pneumonia	92.7
Td	85.7
Tdap	81.9
Herpes zoster	59.1

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Table 4.

Percentage of Respondents Who Refer Patients to Other Locations for Some Routinely Recommended Vaccines, by Practice Size

Practice Size	Refer Children and Adolescents^a(n=551)	Refer Adults^b(n=574)
^a P <.001.
^b P ≤.05.
Solo practice	60.6	62.0
2- Person group	52.4	57.8
Family physician group	38.2	52.1
Multispecialty group	34.5	43.0
Total	44.1	53.5

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The Article in Brief

Vaccines Provided by Family Physicians

Doug Campos-Outcalt , and colleagues

Background This study documents the extent to which family physicians provide vaccinations, an important public health measure, as part of their routine services, as well as their participation in the publicly-funded Vaccines for Children (VFC) program.

What This Study Found Although many family medicine practices provide the most routinely recommended child, adolescent, and adult vaccines, smaller practices report difficulty offering a full array of vaccine products, instead referring patients outside the medical home. Eighty percent of respondents reported providing the most routinely recommended vaccines at their practice sites. A significant proportion, however, reported referring elsewhere for some vaccines (44% for children and adolescent vaccines and 54% for adult vaccines), with the most frequent referral location being a public health department. A higher proportion of solo and two-physician practices than larger practices reported referring patients. One-half of those who refer patients cited lack of adequate payment as the primary reason for referral outside the practice. One-half of respondents indicated they did not participate in the federally funded VFC program, most often due to administrative requirements.

Implications

Nonparticipation in VFC has implications for the family medicine practice's role as a medical home for children and adolescents.
The authors suggest that, given the importance of family physicians in providing health care to children, especially in rural areas, the issue of VFC nonparticipation, the reasons for it, and how it affects other vaccine practices should be studied further.