The sequential schedule for poliovirus immunization factors associated with its adoption by primary care providers

80 Pages·2000·2.6 MB·English

by  Ellis, Melissa Sharyn

YALE
UNIVERSITY
CUSHING/WHITNEY
MEDICAL LIBRARY
Permission to photocopy or microfilm processing
of this thesis for the purpose of individual
scholarly consultation or reference is hereby
granted by the author. This permission is not to be
interpreted as affecting publication of this work or
otherwise placing it in the public domain, and the
author reserves all rights of ownership guaranteed
under common law protection of unpublished
manuscripts.
Signature of Author
h\arc-\A 14, 2.0QC)
Date
Digitized by the Internet Archive
in 2017 with funding from
Arcadia Fund
https://archive.org/details/sequentialscheduOOelli

The Sequential Schedule for Poliovirus Immunization:
Factors Associated with Its Adoption by Primary Care Providers
A Thesis Submitted to the
Yale University School of Medicine
in Partial Fulfillment of the Requirements for the
Degree of Doctor of Medicine
by
Melissa Sharyn Ellis
2000
Yfltf MFPinsi uRPApy
JUI 2 2 2000
TU3>
4 YiX
4 ?33
11
THE SEQUENTIAL SCHEDULE FOR POLIOVIRUS IMMUNIZATION: FACTORS ASSOCIATED
WITH ITS ADOPTION BY PRIMARY CARE PROVIDERS
Melissa S. Ellis, Philip LaRussa, Sally Findley, and Matilde Irigoyen. Department of Pediatrics, Columbia
University, New York, NY. (Sponsored by Eugene Shapiro, Department of Pediatrics, Yale University
School of Medicine, New Haven, CT).
Background and objectives: In January 1997 the Advisory Committee on Immunization Practices (ACIP)
recommended switching from, a schedule consisting solely of oral polio vaccine to a sequential one
consisting of both an inactivated, injectable vaccine and an oral vaccine. The objectives of this project
were to gain a better understanding of how providers learn about changes in immunization policy and to
identify factors that were important to them in deciding whether to adopt the sequential schedule.
Methods: Providers in Northern Manhattan were surveyed between July and August 1997. Data were
collected on the professional qualifications of the providers, their practice demographics, providers’
preferences for information sources, and their current polio immunization practices.
Results: 24% of providers had already adopted the sequential schedule, 40% were planning to adopt it, and
36% were not planning to adopt it. Compared with those who had no plans to switch, providers who either
had already switched or planned to switch were more likely to be members of the American Academy of
Pediatrics (AAP) (64.9% vs. 33.3%, p=0.021), to have a faculty appointment (75.7% vs. 42.9%, p=0.012),
and to prefer using MEDLINE (56.8% vs. 28.6%, p=0.039) or the “Red Book” (51.4% vs. 23.8%, p=0.041)
as sources of vaccination information. All providers identified similar factors that were important in their
vaccination decision making: compliance with ACIP, medical issues, personal judgment, and parental
concerns were considered more important than legal issues, logistic issues, and cost. When asked what
would make them switch to the sequential schedule, providers who were planning to adopt the sequential
schedule most commonly cited stronger recommendations by ACIP while those not planning to adopt cited
a legal mandate by the New York City Department of Health.
Conclusions: Providers who were not planning to adopt the sequential schedule were less likely to be
affiliated with an academic institution, to be AAP members, and to prefer the use of MEDLINE or the “Red
Book” for vaccination information. Our study identified a group of providers that would benefit from more
direct educational interventions to increase compliance with new vaccination practices.