Michelle De Guire

A prenatal intervention study to improve timeliness of immunization initiation in Latino infants.

This was a prospective randomized cohort study to assess the effectiveness of an educational immunization intervention with pregnant Latinas on timely initiation of infant immunization. Study participants were recruited from two community clinics in north San Diego County. A total of three hundred and fifty-two Latinas in the third trimester of pregnancy were recruited and randomly assigned to intervention or control groups. Participants received either a culturally and linguistically appropriate session on infant immunization (intervention) or a session on prevention of Sudden Infant Death Syndrome (control). The main outcome measures were pre-post immunization knowledge change and infant immunization status at 92 days. Immunization knowledge increased significantly in the intervention group [p < .0001, 95%CI (1.76, 2.47)]. No difference was found between groups in immunization series initiation: 95 percent of the children in the intervention group were up-to-date by 92 days from birth, and 93 percent of the control group was up-to-date at 92 days. The lack of significant association between receiving immunization education and infant immunization series initiation suggests that parent education may be necessary but not sufficient for timely immunization, particularly in clinics with effective well-child programs. Given the significant increase in immunization knowledge, the broader and perhaps more important implication is that language- and culturally specific infant health education messages in the prenatal period may have a positive long-term impact on the childs health and promote well-child care overall. Future studies should assess the role of prenatal well-child education in the context of clinics with low immunization levels

Physicians' immunization knowledge, attitudes, and practices: a valid and internally consistent measurement tool.

Because physicians play a crucial role in immunizations,1–3 there is a need for reliable and valid assessments of physician-related determinants of immunizations. As part of a project aimed at improving immunization rates by targeting physicians,4 we developed measures of factors, which, according to theories of planned behavior5 and cognitive social learning,6 influence physicians’ immunization practices. Our measures include knowledge (understanding of the schedule, efficacy, and side effects of vaccines); attitudes (evaluative reactions toward immunizations); vested interest (perceptions of personal professional consequences of immunizations); self-efficacy (beliefs in personal capability to properly immunize); and perceived barriers (factors hindering proper immunizations). With few exceptions,7–9 studies measuring these variables either do not examine or do not report reliability and validity of their measures. Interventions based on potentially unreliable or invalid measures of needs may result in wasted resources or may not detect real improvements in immunization practices. Our measures should be of interest to those who plan interventions to improve physicians’ immunization practices or evaluate the effects of such interventions.

The Cost of Doing Business: Cost Structure of Electronic Immunization Registries

OBJECTIVE To predict the true cost of developing and maintaining an electronic immunization registry, and to set the framework for developing future cost-effective and cost-benefit analysis. DATA SOURCES/STUDY SETTING Primary data collected at three immunization registries located in California, accounting for 90 percent of all immunization records in registries in the state during the study period. STUDY DESIGN A parametric cost analysis compared registry development and maintenance expenditures to registry performance requirements. DATA COLLECTION/EXTRACTION METHODS Data were collected at each registry through interviews, reviews of expenditure records, technical accomplishments development schedules, and immunization coverage rates. PRINCIPAL FINDINGS The cost of building immunization registries is predictable and independent of the hardware/software combination employed. The effort requires four man-years of technical effort or approximately

The Cost to Immunize During Well-Child Visits

250,000 in 1998 dollars. Costs for maintaining a registry were approximately

A valid and reliable measure of physician immunization-relevant knowledge, attitudes, and practices 670

5,100 per end user per three-year period. CONCLUSIONS There is a predictable cost structure for both developing and maintaining immunization registries. The cost structure can be used as a framework for examining the cost-effectiveness and cost-benefits of registries. The greatest factor effecting improvement in coverage rates was ongoing, user-based administrative investment.

Analysis of immunization workflow in clinics serving patients at risk for underimmunization |[dagger]| 631

The objective of this study was to determine the incremental labor costs or opportunity costs associated with the provision of immunizations in ambulatory care settings. A time and motion analysis of primary care health visits by pediatric patients was performed in 10 community clinics and 5 private primary care practices. These clinics and practices were located in areas designated as Health Professional Shortage Areas, with traditionally low immunization coverage rates and other unmet primary care needs. The outcome measure for this study was the comparative duration of the visit, contrasting well-child visits during which immunization was given with well-child visits during which no immunization was given. The results suggested that immunizations present an opportunity cost during well-child visits. The average time of patient-provider contact found in this study supports other findings showing that this time is now significantly longer than that reported in the past. In order for providers to comply with increased recommendations and requirements for preventive health care services, the allotted visit time, capitation rates, and overall clinic system effectiveness need to be reexamined.

Missed Opportunities to Immunize Psychosocial and Practice Correlates

Background: Despite improving trends, immunization rates among U.S. preschool children are still suboptimal. It has been recently recognized that healthcare providers play a critical role in undervaccination. Despite this fact, few reliable and validated instruments to assess immunization knowledge, attitudes, and practices have been developed for use among healthcare providers. In a cross-sectional study involving groups of 38 general pediatricians, 46 subspecialty pediatricians, 11 third-year pediatric residents, and 33 first-year pediatric and family medicine residents an instrument was developed to evaluate provider knowledge, attitudes, and practices.

Provider–Staff Discrepancies in Reported Immunization Knowledge and Practices

Analysis of immunization workflow in clinics serving patients at risk for underimmunization † 631