Effect of the Vaccines for Children program on physician referral of children to public vaccine clinics: a pre-post comparison

Do Florida Medicaid providers' barriers to HPV vaccination vary based on VFC program participation?

This study aimed to determine if physicians' perceived barriers to human papillomavirus (HPV) vaccination were associated with participation in the federal Vaccines for Children (VFC) program. A sample of 800 Florida Medicaid providers was randomly selected from the Florida Medicaid Master Provider File. A cross-sectional study was conducted using a 27-item survey that included 13 potential barriers to immunizing Medicaid patients against HPV, including concerns about vaccine safety and efficacy, discussing sexuality, vaccinated teens practicing riskier sexual behaviors, cost and reimbursement, ensuring 3-dose series completion, and school attendance requirements associated with HPV vaccination. Pearson χ(2) tests were conducted to investigate differences between each barrier and VFC program participation. Data were analyzed for 449 physicians. Compared to non-VFC providers, VFC providers were significantly less likely to somewhat or strongly agree that the following were barriers to vaccination: the cost of stocking the HPV vaccine (p = 0.0011), lack of adequate reimbursement for HPV vaccination (p < 0.0001), and lack of timely reimbursement for HPV vaccination (p < 0.0001). After adjusting for provider specialty and number of years since completion of residency training, VFC status remained significantly associated with the barrier regarding lack of adequate reimbursement for vaccination such that non-VFC providers had a 2.6-fold (95% confidence interval, 1.1-5.8) greater odds of somewhat or strongly agreeing that this barrier applied to them. Increasing participation in the VFC program may decrease physicians' cost-related barriers, which may increase the number of children vaccinated on time according to the recommended schedule.

Estimation of immunization providers' activities cost, medication cost, and immunization dose errors cost in Iraq

The immunization status of children is improved by interventions that increase community demand for compulsory and non-compulsory vaccines, one of the most important interventions related to immunization providers. The aim of this study is to evaluate the activities of immunization providers in terms of activities time and cost, to calculate the immunization doses cost, and to determine the immunization dose errors cost. Time-motion and cost analysis study design was used. Five public health clinics in Mosul-Iraq participated in the study. Fifty (50) vaccine doses were required to estimate activities time and cost. Micro-costing method was used; time and cost data were collected for each immunization-related activity performed by the clinic staff. A stopwatch was used to measure the duration of activity interactions between the parents and clinic staff. The immunization service cost was calculated by multiplying the average salary/min by activity time per minute. 528 immunization cards of Iraqi children were scanned to determine the number and the cost of immunization doses errors (extraimmunization doses and invalid doses). The average time for child registration was 6.7 min per each immunization dose, and the physician spent more than 10 min per dose. Nurses needed more than 5 min to complete child vaccination. The total cost of immunization activities was 1.67 US$ per each immunization dose. Measles vaccine (fifth dose) has a lower price (0.42 US$) than all other immunization doses. The cost of a total of 288 invalid doses was 744.55 US$ and the cost of a total of 195 extra immunization doses was 503.85 US$. The time spent on physicians' activities was longer than that spent on registrars' and nurses' activities. Physician total cost was higher than registrar cost and nurse cost. The total immunization cost will increase by about 13.3% owing to dose errors.

To give or not to give: Approaches to early childhood immunization delivery in Oregon rural primary care practices

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 was sent to all physicians, nurse practitioners, and physician assistants practicing primary care in rural communities throughout Oregon.

FINDINGS

While 39% of rural clinicians reported delivering all childhood immunizations in their clinic, 43% of clinicians reported that they refer patients elsewhere for some vaccinations, and 18% provided no immunizations in the clinic whatsoever. Leading reasons for referral include inadequate reimbursement, parental request, and storage and stocking difficulties. Nearly a third of respondents reported that they had some level of concern about the safety of immunizations, and 14% reported that concerns about safety were a specific reason for referring. Clinicians who delivered only some of the recommended immunizations were less likely than nonreferring clinicians to have adopted evidence-based best immunization practices.

CONCLUSIONS

This study of rural clinicians in Oregon demonstrates the prevalence of barriers to primary care based immunization delivery in rural regions. While some barriers may be difficult to overcome, others may be amenable to educational outreach and support. Thus, efforts to improve population immunization rates should focus on promoting immunization "best practices" and enhancing the capacity of practices to provide immunizations and ensuring that any alternative means of delivering immunizations are effective.

Vaccines provided by family physicians

PURPOSE

This study was conducted to document current immunization practices by family physicians.

METHODS

In 2008 the American Academy of Family Physicians (AAFP) conducted a survey among a random sample of 2,000 of its members who reported spending 80% or more of their time in direct patient care. The survey consisted of questions regarding the demographics of the practice, vaccines that are provided at the physicians' clinical site, whether the practice refers patients elsewhere for vaccines, and participation in the Vaccines for Children (VFC) program.

RESULTS

The response rate was 38.5%, 31.8% after non-office-based respondents were deleted. A high proportion of respondents (80% or more) reported providing most routinely recommended child, adolescent, and adult vaccines at their practice sites. The exceptions were rotavirus vaccine for children and herpes zoster vaccine for adults., A significant proportion, however, reported referring elsewhere for some vaccines (44.1% for children and adolescent vaccines and 53.5% for adult vaccines), with the most frequent referral location being a public health department. A higher proportion of solo and 2-physician practices than larger practices reported referring patients. A lack of adequate payment was listed as the reason for referring patients elsewhere for vaccines by one-half of those who refer patients. One-half of responders do not participate in the VFC program.

CONCLUSIONS

Provision of recommended vaccines by most family physicians remains an important service. Smaller practices have more difficulty offering a full array of vaccine products, and lack of adequate payment contributes to referring patients outside the medical home. The reasons behind the lack of participation in the VFC program deserve further study.

Disparities in human papillomavirus vaccine series initiation among adolescent girls enrolled in Florida Medicaid programs, 2006-2008

PURPOSE

To better understand the human papillomavirus (HPV) vaccine series initiation among 9-17-year-old female Medicaid beneficiaries in Florida programs between June 2006 and December 2008 (n = 237,015).

METHODS

Among the Florida Medicaid enrollees with itemized claims collected (non-managed care organization enrollees), we assessed the association between HPV vaccine series initiation (≥1 vaccine claim) and important demographic characteristics (age, race/ethnicity, program enrollment, area of residence, and length of enrollment).

RESULTS

Among 11-17-year-olds, vaccine initiation increased over time from <1% by December 2006 to nearly 19% by December 2008. By December 2008, HPV vaccine initiation increased with respect to age from 9 (1.6%) to 13 years (22.9%), remained relatively stable from ages 13 to 15 years (between 21% and 22%), and decreased among 16- (18.6%) and 17-year-olds (15.7%). Compared with girls in Pilot or Fee for Service programs, the girls in MediPass or Children's Medical Service Network programs were more likely to have initiated the vaccine series. Within three of the four programs, Hispanics were more likely than non-Hispanic white and black girls to have initiated the vaccine series.

CONCLUSIONS

This study expands the understanding of HPV vaccine initiation to low-income adolescents eligible for free vaccine through the Federal Vaccine for Children program. Increased understanding of reasons for the observed differences, especially by program and race/ethnicity, will aid in developing interventions to improve HPV vaccine initiation.

Financing the delivery of vaccines to children and adolescents: challenges to the current system

Recent increases in the number and costs of vaccines routinely recommended for children and adolescents have raised concerns about the ability of the current vaccine financing and delivery systems to maintain access to recommended vaccines without financial barriers. Here we review the current state of US financing for vaccine delivery to children and adolescents and identify challenges that should be addressed to ensure future access to routinely recommended vaccines without financial barriers. Challenges were considered from the perspectives of vaccine providers; state and local governments; insurers, employers, and other health care purchasers; vaccine manufacturers; and consumers.

Cost of vaccine administration among pediatric practices

OBJECTIVE

The goal was to describe variable costs to providers of delivering childhood immunizations.

METHODS

We documented variable costs (costs that vary with the amount of services rendered), including time spent by pediatric staff members and physicians on immunization-related activities, as well as supply costs and medical waste disposal costs. Ten private pediatric practices in the Denver, Colorado, metropolitan area participated in the study. Among the 7 practices that provided us with payment data, 8 health plans were mentioned by > or = 2 practices. There were 37 different agreements between the health plans and practices for vaccine administration payments.

RESULTS

The total documented variable cost per injection (excluding vaccine cost) averaged $11.51, calculated from the following categories: nursing time, $1.71; billing services, $2.67; nonroutine services, $1.64; registry use, $0.96; physician time, $4.05; supplies, $0.36; medical waste disposal, $0.12. Nonroutine activities primarily included performing vaccine inventory and ordering, providing vaccination records to requesters, and answering parent telephone questions about vaccinations. With the use of a simulation model to compensate for the small number of participating practices, the calculated total variable cost per injection was $11.83. When 2 vaccines were administered, we compared the sum of the 2 payments with the sum of the 2 variable costs ($23.02). More than one third of the payment agreements (13 of 37 agreements) paid the practices less than the combined variable costs for 2 immunizations.

CONCLUSION

This study shows that the variable costs of vaccine administration exceeded reimbursement from some insurers and health plans.

Associations between childhood vaccination status and medical practice characteristics among white, black, and Hispanic children

BACKGROUND

The purpose of the study was to identify and understand associations between characteristics of medical practices where immunization services are delivered and vaccination status among white, black, and Hispanic children aged less than 19 months.

METHODS

Eighty pediatric and family physicians participated in a physician-patient encounters survey that included 684 children aged less than 19 months who received at least 1 vaccination during a randomly selected week in 2003.

RESULTS

According to physicians' responses to survey questions, white children who used large medical practices, and black and Hispanic children who used practices, all enrolled in the Vaccine for Children (VFC) program, were more likely to receive vaccines at the recommended age, but Hispanic children who used large Medicaid practices were less likely to receive them at the recommended age. White children who used medical practices that had a large minority patient population were more likely to have completely missed whole series of vaccines.

CONCLUSION

Medical practice characteristics varied in importance as determinants of childhood vaccination among white, black, and Hispanic children. Understanding how type of medical practice and other medical practice characteristics may impact the receipt of timely preventive health services is vital to improving health care access in underserved populations.

Evaluating accountability in the Vaccines for Children program: protecting a federal investment

The Vaccines for Children (VFC) program supplies health-care providers with federally purchased vaccines at no cost for administration to eligible children. Evaluation of vaccine accountability activities ensures appropriate and timely vaccinations are delivered. Program grantees in 50 states, Washington, five large U.S. metropolitan cities, and five U.S. territories and possessions completed a Web-based survey between December 2002 and January 2003 focused on current vaccine accountability operational systems. Most grantees required providers to complete profiles describing the vaccination needs and demographics of their practices. More than half requested providers use benchmarking data, doses-administered reports, and/or claims or encounter data to determine their VFC program-eligible population size; however, > 65% did not have written procedures for investigating and reconciling discrepancies between estimated vaccine needs and actual vaccine-use data. Most grantees had written standard policies requiring providers to report vaccine loss and wastage routinely and to explain why they occurred. Ninety percent of grantees did not have procedures to check providers for fraud and abuse sanctions, and 52% did not have written procedures to address complaints of vaccine fraud and abuse. These results suggested specific areas in which the Centers for Disease Control and Prevention should work with grantees to improve vaccine accountability practices. As a result, enhancements to the VFC program are being implemented to address these areas and their impact evaluated for their effectiveness in ensuring the continued success of the VFC program in protecting the nation's most vulnerable children and adolescents.

The association of health insurance and continuous primary care in the medical home on vaccination coverage for 19- to 35-month-old children

OBJECTIVE

Our goal was to examine the association of continuous care in the medical home and health insurance on up-to-date vaccination coverage by using data from the National Survey of Children's Health and the National Immunization Survey.

METHODS

Interviews were conducted with 5400 parents of 19- to 35-month-old children to collect data on demographics and medically-verified vaccinations. Health insurance coverage was categorized as always, intermittently, or uninsured for the previous 12 months. Insurance types were private, public, or uninsured. Having a personal doctor or nurse and receiving preventive health care in either the past 12 or 24 months constituted continuous primary care in the medical home. Children were up-to-date if they received all vaccinations by 19 to 35 months of age (>or=4 doses of diphtheria and tetanus toxoids and pertussis vaccine, >or=3 doses of poliovirus vaccine, >or=1 dose of any measles-containing vaccine, >or=3 doses of Haemophilus influenzae type b vaccine, and >or=3 doses of hepatitis B vaccine).

RESULTS

Bivariate analyses revealed children who were always insured had significantly higher vaccination coverage (83%) than those with lapses or uninsured during the past 12 months (75% and 71%, respectively). Those with continuous primary care in the medical home had significantly higher coverage than those who did not (83% vs 75%, respectively). In multivariate analysis, the same pattern of association was observed for insurance status and medical home, but the only statistically significant association was for children of never-married mothers who had significantly lower coverage (74%) compared with children of married mothers (84%).

CONCLUSIONS

Among children with the same insurance status and continuity of care in the medical home, children of single mothers were less likely to be up-to-date than children of married mothers. Interventions assisting single mothers to obtain preventive care for their children should be a priority.

Impact of vaccine economic programs on physician referral of children to public vaccine clinics: a pre-post comparison

Background

The Vaccines for Children (VFC) Program is a major vaccine entitlement program with limited long-term evaluation. The objectives of this study are to evaluate the effect of VFC on physician reported referral of children to public health clinics and on doses administered in the public sector.

Methods

Minnesota and Pennsylvania primary care physicians (n = 164), completed surveys before (e.g., 1993) and after (2003) VFC, rating their likelihood on a scale of 0 (very unlikely) to 10 (very likely) of referring a child to the health department for immunization.

Results

The percentage of respondents likely to refer was 60% for an uninsured child, 14% for a child with Medicaid, and 3% for a child with insurance that pays for immunization. Half (55%) of the physicians who did not participate in VFC were likely to refer a Medicaid-insured child, as compared with 6% of those who participated (P < 0.001). Physician likelihood to refer an uninsured child for vaccination, measured on a scale of 0 to 10 where 10 is very likely, decreased by a mean difference of 1.9 (P < 0.001) from pre- to post-VFC. The likelihood to refer a Medicaid-insured child decreased by a mean of 1.2 (P = 0.001).

Conclusion

Reported out-referral to public clinics decreased over time. In light of increasing immunizations rates, this suggests that more vaccines were being administered in private provider offices.

The association between having a medical home and vaccination coverage among children eligible for the vaccines for children program

BACKGROUND

The Vaccines for Children (VFC) program is designed to reduce the cost of vaccines for vulnerable children, including Medicaid-eligible children, American Indian/Alaska Native children, uninsured children, and underinsured children whose health insurance does not cover the cost of vaccinations. A desired consequence of the program is to promote comprehensive continuous medical care within a medical home for these children.

OBJECTIVES

To explore how having a medical home is associated with vaccination coverage among children eligible for the program.

PARTICIPANTS

A total of 24514 children 19 to 35 months of age sampled by the National Immunization Survey.

DESIGN

VFC eligibility was evaluated for 24514 children 19 to 35 months of age who were sampled by the National Immunization Survey. Children were considered to have a medical home if they had a doctor, nurse, or physician's assistant who provided them with ongoing routine care, including well-child care, preventive care, and sick care, according to their parents. Sampled children were determined to be 4:3:1:3:3 up-to-date (UTD) if their vaccination providers reported administering >or=4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, >or=3 doses of polio vaccine, >or=1 dose of measles-mumps-rubella vaccine, >or=3 doses of Haemophilus influenzae type b vaccine, and >or=3 doses of hepatitis B vaccine.

RESULTS

Nationally, 44.9% of all children were VFC eligible and 93.0% of the VFC-eligible children received all vaccine doses at a provider enrolled in the VFC program. Compared with children who were not VFC eligible, VFC-eligible children were less likely to be UTD (70.8% vs 77.7%) and less likely to have a medical home (82.1% vs 95.0%). However, among VFC-eligible children, children who had a medical home were significantly more likely to be UTD, compared with children who did not have a medical home (72.3% vs 63.5%). Also, among VFC-eligible children who had a medical home, children who used their medical home consistently to receive all of their vaccination doses were significantly more likely to be UTD, compared with children who did not receive all of their doses from their medical home (75.3% vs 65.7%). Finally, the 4:3:1:3:3 vaccination coverage rate among VFC-eligible children who received all of their vaccination doses from their medical home was not significantly different from that among non-VFC-eligible children, after controlling for significant differences in sociodemographic factors between these groups (adjusted difference: 2.8%; 95% confidence interval: -0.1% to 5.7%).

CONCLUSIONS

Although the vaccination coverage rate among VFC-eligible children who had a medical home and received all vaccine doses from their medical home was essentially equivalent to that of non-VFC-eligible children, substantial percentages of VFC-eligible children either did not have a medical home or did not use their medical home to receive all of their recommended vaccinations. The vaccination coverage rate among these children was significantly lower. This suggests that there may be opportunities to increase vaccination coverage by removing barriers that prevent the adoption and consistent use of a medical home among these children.

The cost of giving childhood vaccinations: differences among provider types

OBJECTIVE

To describe costs to providers of delivering childhood immunizations.

METHODS

We collected variable costs--costs that vary with the amount of services rendered--including cost of practitioner and staff time and supplies, using a cost accounting method, from 12 practices (4 pediatric practices, 4 family practices, and 4 public health agencies) in rural and urban areas in Colorado. For private practices, we estimated fixed costs--costs that do not vary with the amount of services, eg, rent and insurance). We also collected reimbursement information for vaccinations for private practices.

RESULTS

Variable costs per shot (excluding vaccine cost) were 8.15 dollars for pediatric practices, 5.79 dollars for family practices, and 5.41 dollars for public health agencies. Total costs per shot, including fixed costs, were 10.67 dollars for pediatric practices and 7.57 dollars for family practices. Average reimbursement for pediatricians and private family practices was 8.27 dollars and 6.68 dollars, respectively. For pediatric practices, average variable costs were barely exceeded by average reimbursement, and reimbursement was 22% less than average total costs. This contrasts with an earlier study of the rural practices investigated here, in which there was a comfortable margin between reimbursement and variable costs.

CONCLUSION

The decline in the ratio of reimbursement to cost for private practices, particularly for pediatric practices, suggests that referral to public agencies by private providers for vaccinations may increase and that if vaccinations are not as frequently provided in the child's medical home, then the currently high childhood immunization rates may be in jeopardy.

Financing immunizations in the United States

Children in the United States receive immunizations through both private and public sectors. The federal government has supported childhood immunization since 1963 through the Vaccination Assistance Act (Section 317 of the Public Health Service Act). Since 1994, the Vaccines for Children (VFC) program has provided additional support for childhood vaccines. In 2002, 41% of childhood vaccines were purchased through VFC, 11% through Section 317, 5% through state and/or local governments, and 43% through the private sector. The recent introduction of more-expensive vaccines, such as pneumococcal conjugate vaccine, has highlighted weaknesses in the current system. Adult immunization is primarily performed in the private sector. Until 1981, there was no federal support for adult immunization. Since 1981, Medicare has reimbursed the cost of pneumococcal vaccine for its beneficiaries; influenza vaccine was added in 1993. This paper summarizes the history of financing immunizations in the United States and discusses some current problems and proposed solutions.

Physician attitudes and beliefs associated with patient pneumococcal polysaccharide vaccination status

BACKGROUND

Barriers to adult immunizations persist as current rates for pneumococcal polysaccharide vaccine (PPV) receipt among eligible adults remain below national goals. This study investigated potential barriers to patients receiving the PPV, including predisposing, enabling, environmental and reinforcing factors among physicians from a variety of practice and geographic settings.

METHODS

Participants were 60 primary care physicians from inner-city, rural, suburban, and Veterans Affairs practices, which included adults aged 65 years and older. Elderly patients able to complete a telephone interview were randomly selected from each physician's practice.

RESULTS

Self-reported PPV vaccination status was significantly related to physician report of routinely providing PPV to their patients and to the practice providing immunization clinics or other immunization promotion programs. Physicians who were highly unlikely to refer uninsured adults to health departments for immunizations had a significantly higher percentage of patients reporting receipt of PPV (P = .03).

CONCLUSIONS

Enabling and environmental factors related to physicians, such as economic and insurance issues, were significant barriers to PPV vaccination. Vaccination rates might be improved through efforts that reduce likelihood of referral for immunizations and office systems that support immunization, such as patient and provider reminders and express vaccination clinics.

Influence of insurance status and vaccine cost on physicians' administration of pneumococcal conjugate vaccine

OBJECTIVE

In 2000, heptavalent pneumococcal conjugate vaccine (PCV7) was recommended for children younger than 2 years, but its high cost relative to other universally recommended childhood immunizations and variability in insurance coverage for the vaccine raised concerns. We investigated the influence of PCV7 cost and insurance coverage on physician recommendation of PCV7 to their patients and administration of PCV7 in their practices.

METHODS

We conducted a mail survey from April to July 2001 of a random sample of 833 pediatricians and 788 family physicians in 24 states with different vaccine financing strategies (Vaccines for Children [VFC]-only; enhanced VFC; universal purchase). Physicians specified the proportion of children in their practice with insurance coverage for PCV7, where they recommend administering PCV7, and whether they have concerns about the cost of PCV7.

RESULTS

The response rate was 60%. Overall, 87% of physicians recommend PCV7 for children younger than 2 years (99% pediatricians; 68% family physicians). Among physicians who recommend PCV7, 98% said that they would administer the vaccine in their own practices for children whose insurance covers the vaccine. However, only 56% of physicians who recommend PCV7 reported that all children in their practices had insurance coverage for the vaccine, whereas 24% of physicians reported 86% to 99% of children with coverage and 20% reported <or=85% of children with coverage. Among physicians in the last group with the lowest PCV7 insurance coverage rates in their practices, only 44% said that they would administer the vaccine in their own practices to children without PCV7 coverage, compared with 62% of physicians who provide care to children with higher rates of PCV7 coverage. Physicians in states with VFC-only vaccine financing strategies for PCV7 are less likely to administer PCV7 in their own practices to children without coverage than physicians in states with enhanced VFC and universal purchase strategies (48% vs 64% vs 74%). Almost one third of physicians who recommend PCV7 are concerned about the cost of PCV7; those with cost concerns are more likely to recommend that children without insurance coverage for PCV7 receive the vaccine at a public health clinic rather than in their own practices (45% vs 29%). Physicians with cost concerns are also more likely to say that they now screen children for insurance coverage more than for previously recommended vaccines (52% vs 21% for physicians without cost concerns).

CONCLUSIONS

Nationwide, physician adoption of PCV7 recommendations is high, but where physicians recommend that PCV7 be administered differs significantly by children's variable insurance coverage for the vaccine and by state vaccine financing strategies. Physicians' concerns about the cost of PCV7 may foreshadow their responses to future children's vaccines that may be even more expensive.

Physician knowledge of catch-up regimens and contraindications for childhood immunizations

OBJECTIVES

To determine physician success at designing catch-up regimens for children delayed in immunizations and physician knowledge regarding contraindications to immunization.

METHODS

A self-administered survey was completed by pediatricians, general practitioners, and family practitioners in Cook County, Illinois. Surveys included 6 open-ended vignettes describing hypothetical children delayed in immunization for whom participants were asked to design catch-up regimens. Bivariate and multivariate logistic regression were used to determine predictors of correct response. The surveys also inquired about management of scenarios that might be perceived as contraindications to immunize with the Haemophilus influenzae type b or measles-mumps-rubella vaccines.

RESULTS

The mean score of correct responses was 1.83 of a possible 6.0. Almost one third of respondents answered all 6 vignettes incorrectly. The proportion of incorrect responses was high for all 6 vignettes (39%-86%), but higher for questions that addressed the immunization of children older than 12 months. Errors in vaccine administration were most commonly attributed to omitted vaccines, with varicella-zoster vaccine and pneumococcal conjugate vaccine omitted most frequently. Pediatricians were >4 times more likely to answer correctly than were family practitioners. Participants in the Vaccines for Children (VFC) program were more than twice as likely to answer correctly than were non-VFC providers. Knowledge of contraindications was inconsistent, particularly for measles-mumps-rubella vaccine.

CONCLUSIONS

Childhood vaccine providers have substantial knowledge deficits of recommended immunization schedules and vaccine contraindications that may contribute to missed opportunities to immunize. Pediatricians and participants in the VFC program were more successful at designing catch-up regimens for children with immunization delay.

The vaccines for children program. Policies, satisfaction, and vaccine delivery

OBJECTIVES

Characterize the Vaccines for Children (VFC) programs in Minnesota and Pennsylvania, assess providers' satisfaction with each state's program, and examine changes in doses administered in the public sector since implementation of the VFC.

METHODS

Primary care providers participating in the VFC in Minnesota and Pennsylvania were surveyed. Doses administered were based on data from the National Immunization Survey. Outcome measures included satisfaction, ease of use of VFC, doses of immunizations administered through public health departments, and overall immunization coverage for the two states.

RESULTS

Most participating providers in each state (80% to 94%) reported overall satisfaction with the VFC. Pennsylvania physicians were less satisfied with quarterly ordering of immunizations than were Minnesota providers with monthly ordering (56% vs 80%, p<0.05). The most common recommendation was to reduce paperwork. Doses administered in the public sector declined in Minnesota from approximately 146,000 in 1994 to 65,400 in 1999, and in Pennsylvania from approximately 250,000 to 79,300 during the same period.

CONCLUSIONS

The VFC appears to increase the numbers of poor and uninsured children who receive necessary childhood immunizations within their medical homes. Providers are generally satisfied with the program.