To Give or Not to Give: Approaches to Early Childhood Immunization Delivery in Oregon Rural Primary Care Practices

Abstract

Context-Little is known about rural clinicians' perspectives regarding early childhood immunization delivery, their adherence to recommended best immunization practices, or the specific barriers they confront.Purpose-To examine immunization practices, beliefs, and barriers among rural primary care clinicians for children in Oregon and compare those who deliver all recommended immunizations in their practices with those who do not.Methods-A mailed questionnaire sent to all physicians, nurse practitioners, and physician assistants practicing primary care in rural communities throughout Oregon.

Healthcare Providers’ Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review

“…Recommendation behavior differed by specialties. Pediatricians were more likely to recommend or offer vaccines [ 118 ] (AOR = 2.55) [ 52 ] than OBGYNs (AOR = 0.5) [ 101 ], family physicians (FP) (A/OR = 2.0–3.49) [ 46 , 47 , 84 , 116 , 127 , 129 ], and GP [ 46 , 47 , 118 ]. Pediatricians placed greater importance than FPs on guidelines (67% vs. 44%, OR = 2.6) and parental requests (61% vs. 45%, OR = 1.9) regarding varicella vaccine [ 84 ].…”

“…Believing vaccines would be accepted by vaccinators [ 74 ] (OR = 6.41) [ 92 ], vaccine providers (OR = 6.65) [ 39 ], and other professionals (OR = 7.39) [ 57 ] had positive associations. Reported barriers included lack of time [ 63 , 67 , 78 , 82 , 83 , 94 ], logistical difficulties [ 45 , 48 , 63 , 67 , 68 , 95 , 116 ] such as storage [ 85 ], and failure to discuss the vaccine during visits [ 117 ].…”

“…Place of practice was another frequently studied variable. Physicians working in larger [ 60 , 129 ], private, single-specialty (B = 0.28) [ 109 ], and solo (OR = 0.29) [ 72 ] practices, preventative rather than curative services [ 107 ], urban compared to rural locations [ 76 , 100 , 116 ], and metro versus regional areas (AOR = 0.25) [ 71 ] were more likely to recommend or adopt vaccines. Working in neighborhood or community health centers was common amongst HCPs who were reluctant to follow official organizations’ varicella vaccine recommendations [ 87 ], but another study found greater hesitancy toward the influenza vaccine in HCPs practicing in secondary (OR = 0.61) and tertiary (OR = 0.48) hospitals compared to those working in community health centers [ 65 ].…”

Barriers to and facilitators of early childhood immunization in rural areas of the United States: A systematic review of the literature

“…Studies have demonstrated persistent disparities in rural settings compared to urban areas in general health care access ( Douthit et al, 2015 ) and mortality ( Moy et al, 2017 ) indicating unique challenges to accessing medical care and preventive health services in rural communities. Although studies have demonstrated rural versus urban differences in variation in immunization delivery ( Fagnan et al, 2011 , O'Leary et al, 2015 ), explanations specific to why rural children are undervaccinated remains understudied.…”

An Acquisition Support System for Public Healthcare — Case Study of the U.S. Children Vaccine Program

“…One major area where vaccine wastage occurs is during childhood immunizations, which is conpounded by the challenge of incorporating new vaccines into the already crowded immunization schedule adopted by the U.S. governement. In addition, an increasing numbers of health providers and parents are opposed to add immunization requirements, which prevents an efficient resource management [6][7][8].…”