Immunization Status and Reasons for Immunization Delay Among Children Using Public Health Immunization Clinics

Abbotts, Bruce

doi:10.1001/archpedi.1993.02160330055018

Cited by 21 publications

(16 citation statements)

References 18 publications

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“…That conclusion is supported by other research that suggests that parental concern about injections affects their compliance with medical care. 13 Similar unease exists among providers. Woodin et al 14 reported that, depending on the child's age, 56% to 65% of practicing physicians had strong concerns about 3 injections at a single visit.…”

mentioning

confidence: 98%

Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations

et al. 2007

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The pain associated with immunizations is a source of anxiety and distress for the children receiving the immunizations, their parents, and the providers who must administer them. Preparation of the child before the procedure seems to reduce anxiety and subsequent pain. The limited available data suggest that intramuscular administration of immunizations should occur in the vastus lateralis (anterolateral thigh) for children <18 months of age and in the deltoid (upper arm) for those >36 months of age. Controversy exists in site selection for 18- to 36-month-old children. A number of studies suggest that the ventrogluteal area is the most appropriate for all age groups. Longer needles are usually associated with less pain and less local reaction. During the injection, parental demeanor clearly affects the child's pain behaviors. Excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. Distraction techniques vary with the age, temperament, and interests of the child, but their efficacy is well supported in the literature. Sucrose solution instilled directly into the mouth or administered on a pacifier reduces evidence of distress reliably in children <6 months of age and should be used routinely. Although there is no perfect topical anesthetic available at this time, selective use for children who are particularly fearful or who have had negative experiences in the past is highly endorsed. Pressure at the site, applied with either a device or a finger, clearly reduces pain. Finally, in the era of multiple injections, it seems that parents prefer that multiple injections be given simultaneously, rather than sequentially, if there are enough personnel available. Immunizations are stressful for many children; until new approaches are developed, systematic use of available techniques can significantly reduce the burden of distress associated with these procedures.

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confidence: 98%

Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations

et al. 2007

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“…Providers should be particularly aware of the need for careful explanations of vaccine options and risks, and be prepared to give a clear recommendation to parents on vaccines and vaccine schedules. [12][13][14][15] One limitation to this study is that approximately 35 interviewers administered the surveys. The large number of interviewers resulted from the number of clinics surveyed, the extended hours that the clinics were open, and interviewer attrition over the six month survey period.…”

Section: Discussionmentioning

confidence: 99%

Parental Attitudes Toward Multiple Poliovirus Injections Following a Provider Recommendation

Kolasa¹

2001

Public Health Reports

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SYNOPSISObjectives. Changes to the polio vaccination schedule, first to a sequential inactivated poliovirus/oral poliovirus (IPV/OPV) schedule in 1996 and most recently to an all-IPV schedule, require infants to receive additional injections. Some surveys show parental hesitation concerning extra injections, whereas others show that parents prefer multiple simultaneous injections over extra immunization visits. This study describes parental behavior and attitudes about the poliovirus vaccine recommendations and additional injections at the 2-and 4-month immunization visits.Methods. Beginning July 1, 1996, providers in eight public health clinics in Cobb and Douglas Counties, Georgia, informed parents of polio vaccination options and recommended the IPV/OPV sequential schedule. A cross-sectional clinic exit survey was conducted from July 15, 1996, to January 31, 1997, with parents whose infants (younger than 6 months) were eligible for a first poliovirus vaccination.Results. Of approximately 405 eligible infants, parents of 293 infants were approached for an interview, and 227 agreed to participate. Of those 227 participants, 210 (92%) parents chose IPV for their infant and 17 (8%) chose OPV. Of greatest concern to most parents was vaccine-associated paralytic polio (VAPP) (155, or 68.3%); the next greatest concern was an extra injection (22, or 9.7%). These parental concerns were unrelated to the number of injections the infant actually received.Conclusions. After receiving information on polio vaccination options and a provider recommendation, parents overwhelmingly chose IPV over OPV. Concern about VAPP was more common than objection to an extra injection. The additional injection that results from using IPV for an infant's first poliovirus vaccination appears to be acceptable to most parents.

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“…[114][115][116] Whilethisisdue in part to poor public awareness and to financial and systems barriers, 117,118 physicians also contribute 119 through missed opportunities, 120,121 failure to administer multiple vaccines during the same visit, 122 inappropriately broadening contraindications to vaccination, 123 and forgetting to assess the vaccinationstatusofpatients. 124 Weingarten et al 125 found that primary care physicians grossly overestimated their influenza and pneumococcal vaccination practices when self-report was compared with the medical record.…”

Section: Vaccinationmentioning

confidence: 99%

Comparing Generalist and Specialty Care

Donohoe

1998

Arch Intern Med

166

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Policymakers, managed care organizations, medical educators, and the general public are showing an increasing interest in the amount and quality of care provided by generalists and subspecialists. This article reviews studies comparing the knowledge base of and quality of care provided by these 2 groups of physicians. English-language articles were identified through MEDLINE (1966-present) using the following keywords: generalist, generalism, (sub)specialist, (sub)specialty, (sub)specialization, consultation, referral, and quality of care, and through the bibliographies of these citations. All studies were evaluated. With respect to quality of care, only American studies were chosen. Data quality was assessed by me. Evidence is strongest that the knowledge base and quality of care provided by specialists exceeds those of generalists for certain conditions such as myocardial infarction, depression, and acquired immunodeficiency syndrome. Differences in many other areas are multifactorial, and often a function of study design or patient selection. The differences, however, are not as striking or important to the health of the public at large as those deficiencies in disease management, preventive care, and health maintenance that are common to all physicians. Furthermore, overuse of diagnostic and therapeutic modalities by certain specialists leads to increased costs with either no benefit or added risks to patients. The quality and coordination of care provided by generalists and specialists may be improved through changes in education and training, via quality improvement methods of providing patient care, and by increasing visit length and optimizing use of referrals and strategies for generalist-specialist comanagement. Further study of these areas is warranted and should concentrate on outcomes.Arch Intern Med. 1998;158:1596-1608 This article evaluates the amount and quality of care provided by generalists and specialists, a subject of increasing interest to medical educators, managed care organizations, and the general public. Weaknesses in the knowledge base of practicing physicians are reviewed, and investigations attempting to compare generalist and specialty care for common conditions are described. While some of the differences in quality of care may be due to generalists' knowledge deficits, many are secondary to system factors and most are remediable. Furthermore, disparities between generalist and specialty care likely have less impact on the population's health than the deficiencies all physicians share. After discussing the nature of these deficiencies, I explain how they might be corrected and how generalists and specialists can work together, building on their respective strengths, to improve the quality of health care in this country.

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Immunization Status and Reasons for Immunization Delay Among Children Using Public Health Immunization Clinics

Cited by 21 publications

References 18 publications

Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations

Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations

Parental Attitudes Toward Multiple Poliovirus Injections Following a Provider Recommendation

Comparing Generalist and Specialty Care

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