Bordley W C, Freed G L, Garrett J M, Byrd C A, Meriwether R
Department of Pediatrics, University of North Carolina at Chapel Hill 27599-7590.
Pediatrics. 1994 Sep;94(3):376-80.
Despite the existence of Medicaid and other programs designed to eliminate cost as a barrier to immunization in physicians' offices, referrals to local health departments for immunizations are common. Many children leave their physicians' offices without receiving needed immunizations.
To determine: 1) the frequency and determinants of immunization referrals to health departments in North Carolina, and 2) the factors associated with private physicians' decisions to immunize Medicaid children in their offices and participate in the state-funded vaccine replacement program.
The 2537 pediatricians and family physicians licensed in North Carolina were surveyed by mail using a 23-item, self-administered questionnaire.
Seventy-two percent of physicians responded; 93% referred at least some children to local health departments for immunizations. Concern regarding parents' ability to pay for immunizations was the most important reason for referral for 93% of respondents. Forty percent referred all or some of their Medicaid patients; excessive paperwork, inadequate reimbursement, and parental preferences were the most common reasons. Only 33% of physicians had participated in the state's vaccine replacement program. Family physicians, and physicians in solo or two-physician practices in rural counties, and in practices caring for a small number of children on Medicaid were most likely to refer children covered by Medicaid and not participate in the state's existing vaccine replacement program.
Medicaid and North Carolina's vaccine replacement program are not preventing large numbers of immunization referrals to health departments. Future programs designed to increase the proportion of children immunized in physicians' offices will not succeed if more effective incentives for physician participation are not developed.
尽管存在医疗补助计划以及其他旨在消除费用障碍以使儿童能在医生办公室接种疫苗的项目，但将儿童转介至当地卫生部门进行疫苗接种的情况仍很常见。许多儿童在离开医生办公室时并未接种所需疫苗。
确定：1）北卡罗来纳州将疫苗接种转介至卫生部门的频率及决定因素；2）与私人医生在其办公室为医疗补助儿童接种疫苗以及参与州资助的疫苗更换计划的决定相关的因素。
通过邮件向在北卡罗来纳州获得执照的2537名儿科医生和家庭医生发放一份包含23个项目的自填式问卷进行调查。
72%的医生回复；93%的医生至少将一些儿童转介至当地卫生部门进行疫苗接种。93%的受访者表示，对家长支付疫苗接种费用能力的担忧是转介的最重要原因。40%的医生将其全部或部分医疗补助患者进行了转介；繁琐的文书工作、报销不足以及家长的偏好是最常见的原因。只有33%的医生参与了该州的疫苗更换计划。家庭医生、在农村县独自执业或两人执业的医生以及为少量医疗补助儿童提供服务的医生最有可能将医疗补助覆盖的儿童转介出去，且不参与该州现有的疫苗更换计划。
医疗补助计划和北卡罗来纳州的疫苗更换计划未能阻止大量疫苗接种转介至卫生部门的情况。如果不能制定出更有效的激励措施促使医生参与，未来旨在提高在医生办公室接种疫苗儿童比例的项目将不会成功。
