SAN FRANCISCO - Pediatricians are more likely than family physicians (FPs) toadminister varicella vaccine (Varivax, Merck & Co.), according to a study presented here recently at the Pediatric Academic Society Meeting.
The physicians' behavior may be influenced by their treatment experience. Pediatricians may be more aware of the complications of varicella infection because they have seen first hand the complications of varicella. This could affect their likelihood of administering the vaccine.
"I think pediatricians have probably treated someone with complications of varicella," explained Anita R. Chandra-Puri, MD, lead author of the study and a pediatrician at Children's Memorial Hospital/Northwestern University in Chicago.
In addition, pediatricians were also more likely to give the vaccine at the age recommended. The American Academy of Pediatrics and the American Academy of Family Physicians both recommend that varicella vaccine be given to children 12-18 months of age. The Advisory Committee on Immunization Practices also recommends the vaccine at this age. The vaccine was licensed for use in the United States in 1995.
Between March and November 1998, Chandra-Puri and her colleagues randomly surveyed 1,000 pediatricians and 1,000 family practitioners in three mailings. More than 1,000 physicians responded (663 pediatricians, 475 FPs). The researchers analyzed the responses of 547 pediatricians and 393 family practitioners who provided primary care to children in a community or academic setting and who administered immunizations in their offices. Residents and research faculty were excluded.
The questionnaire asked questions about demographics, experience with varicella, and varicella vaccine usage and attitudes.
Among the respondents, 55% of pediatricians and 74% of FPs were men. Eighteen percent of pediatricians and 22% of FPs were in solo practices. Nineteen percent of pediatricians and 37% of FPs practiced in a rural area.
Twenty five percent of pediatricians surveyed and 14% of family physicians surveyed have practices that are comprised of > 40% Medicaid-insured children. More than 70% of pediatricians took advantage of the Vaccines for Children Program (VFC), as opposed to 58% of FPs. VFC is a federal program than provides vaccines free to needy children.
The researchers found that 85% of pediatricians vs. 49% of FPs were more likely to offer varicella vaccine all of the time (P<.001). In addition, among those offering the vaccine, 90% of pediatricians vs. 80% of FPs were more likely to offer the vaccine at the recommended ages (P<.001).
Various items influenced physician behavior, according to the researchers. These included guidelines (93% pediatricians vs. 83% FPs); disease complications (52% pediatricians vs. 23% FPs); and practice policy (37% pediatricians vs. 25% FPs).
"Participation in vaccine provision pro grams that provide varicella vaccine was associated with increased use by both pediatricians and family practitioners," the researchers said in their poster.
"Expansion of free or reduced-cost vaccine programs and education of family physicians regarding varicella complications may be associated with increased use of varicella vaccine," they concluded.
Varicella affects nearly 4 million people in the United States each year, mostly children. Family practitioners are an important component of the U.S. vaccination program, as 20% of all pediatric office visits are to family physicians, according to the researchers.
For more information:
- Chandra-Puri AR, Binns HJ, Tanz RR. Varicella vaccine: Hot shot or not? Abstract 72. Presented at the Pediatric Academic Societies 1999 Annual Meeting, sponsored by the American Pediatric Society, Society for Pediatric Research and Ambulatory Pediatric Association. May 1-4. San Francisco.
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