ObjectiveImmunizations are an important component of well child care, yet children around the world are commonly not fully immunized. The goal of this research was to assess current immunization practices, perceived barriers to immunization, and identify strategies that might improve immunization rates. Design setting and Rural family and general practitioners in the 52 nonmetropolitan statistical area measurement counties of Colorado who might include the care of children in their practice were surveyed regarding their immunization practices. Responses were used to identify ways in which these physicians comply with published standards for immunization practices and the barriers they perceived to immunization.
ResultsNearly all rural Colorado family and general practitioners provide services to children, and most currently provide immunizations. The majority send at least some of their patients to other sources of care for immunizations. Common deficiencies in immunization practices and patient barriers are similar to those encountered internationally. These include not immunizing at sick visits, not providing for 'walk-in' immunizations, not making immunization available during evenings and weekends, failing to perform immunization screening at every visit and having no formal reminder or tracking systems. Patient barriers include cost, parental attitudes, language barriers, transportation and patient mobility. Provider barriers are lack of availability of immunization records (immunization tracking), low reimbursement rates, problems with keeping small volumes of vaccines, record-keeping problems and their own failure to counsel parents about the importance of immunization, to immunize at sick visits and to screen for immunization status at all visits.
Implications forRural family physicians and general practitioners are well positioned to have practice a positive impact on childhood immunization rates, as they provide the majority of care to rural children. Better adherence to standards for immunization practice should help improve immunization rates. Problems related to reimbursement and immunization tracking are likely to remain.
BackgroundNorovirus is a leading cause of acute gastroenteritis (AGE) across the age spectrum; candidate vaccines are in clinical trials. While norovirus diagnostic testing is increasingly available, stool testing may not be performed routinely, which can hamper surveillance and burden of disease estimates. Our objectives were to understand physicians’ stool testing practices in outpatients with AGE, and physician knowledge of norovirus, in order to improve surveillance and prepare for vaccine introduction.MethodsInternet and mail survey on AGE and norovirus conducted January to March 2018 among national networks of primary care pediatricians (Peds), family practice (FP) and general internal medicine (GIM) physicians.ResultsThe response rate was 59% (820/1,383). During peak AGE season, physicians estimated they ordered stool tests for a median of 15% (interquartile range: 5–33%) of their outpatients with AGE. Stool tests were more often available for ova and parasites, Clostridioides difficile, and bacterial culture (>95% for all specialties) than for norovirus (6–33% across specialties); even when available, norovirus-specific tests were infrequently ordered. Most providers were unaware that norovirus is a leading cause of AGE across all age groups (Peds 80%, FP 86%, GIM 89%) or that alcohol-based hand sanitizers are ineffective against norovirus (Peds 51%, FP 66%, GIM 62%).ConclusionPhysicians infrequently order stool tests for outpatients with AGE, and have knowledge gaps on norovirus prevalence and hand hygiene for prevention. Understanding the limitations of surveillance that relies on physician-ordered stool diagnostics, and closing physician knowledge gaps, can help support norovirus vaccine introduction.Disclosures
All authors: No reported disclosures.
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