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  • American Academy of Pediatrics (AAP)  (6)
  • Crane, Lori A.  (6)
  • 1
    Online Resource
    Online Resource
    Use of Standing Orders for Vaccination Among Pediatricians
    American Academy of Pediatrics (AAP) ; 2020
    In:  Pediatrics Vol. 145, No. 5 ( 2020-05-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 145, No. 5 ( 2020-05-01)
    Abstract: Standing orders are an effective way to increase vaccination rates, yet little is known about how pediatricians use this strategy for childhood immunizations. We assessed current use of, barriers to using, and factors associated with use of standing orders for vaccination among pediatricians. METHODS: Internet and mail survey from June 2017 to September 2017 among a nationally representative sample of pediatricians. In the principal component analysis of barrier items, we identified 2 factors: physician responsibility and concerns about office processes. A multivariable analysis that included barrier scales and physician and/or practice characteristics was used to identify factors associated with use of standing orders. RESULTS: The response rate was 79% (372 of 471); 59% of respondents reported using standing orders. The most commonly identified barriers among nonusers were concern that patients may mistakenly receive the wrong vaccine (68%), concern that patients prefer to speak with the physician about a vaccine before receiving it (62%), and belief that it is important for the physician to be the person who recommends a vaccine to patients (57%). These 3 items also made up the physician responsibility barrier factor. Respondents with higher physician responsibility scores were less likely to use standing orders (risk ratio: 0.59 [95% confidence interval: 0.53–0.66] per point increase). System-level decision-making about vaccines, suburban or rural location, and lower concerns about office processes scores were each associated with use of standing orders in the bivariate, but not the multivariable, analysis. CONCLUSIONS: Among pediatricians, use of standing orders for vaccination is far from universal. Interventions to increase use of standing orders should address physicians’ attitudinal barriers as well as organizational factors.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2019-1855
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2020
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  • 2
    Online Resource
    Online Resource
    Vaccine Financing From the Perspective of Primary Care Physicians
    American Academy of Pediatrics (AAP) ; 2014
    In:  Pediatrics Vol. 133, No. 3 ( 2014-03-01), p. 367-374
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 133, No. 3 ( 2014-03-01), p. 367-374
    Abstract: Because of high purchase costs of newer vaccines, financial risk to private vaccination providers has increased. We assessed among pediatricians and family physicians satisfaction with insurance payment for vaccine purchase and administration by payer type, the proportion who have considered discontinuing provision of all childhood vaccines for financial reasons, and strategies used for handling uncertainty about insurance coverage when new vaccines first become available. METHODS: A national survey among private pediatricians and family physicians April to September 2011. RESULTS: Response rates were 69% (190/277) for pediatricians and 70% (181/260) for family physicians. Level of dissatisfaction varied significantly by payer type for payment for vaccine administration (Medicaid, 63%; Children’s Health Insurance Program, 56%; managed care organizations, 48%; preferred provider organizations, 38%; fee for service, 37%; P & lt; .001), but not for payment for vaccine purchase (health maintenance organization or managed care organization, 52%; Child Health Insurance Program, 47%; preferred provider organization, 45%; fee for service, 41%; P = .11). Ten percent of physicians had seriously considered discontinuing providing all childhood vaccines to privately insured patients because of cost issues. The most commonly used strategy for handling uncertainty about insurance coverage for new vaccines was to inform parents that they may be billed for the vaccine; 67% of physicians reported using 3 or more strategies to handle this uncertainty. CONCLUSIONS: Many primary care physicians are dissatisfied with payment for vaccine purchase and administration from third-party payers, particularly public insurance for vaccine administration. Physicians report a variety of strategies for dealing with the uncertainty of insurance coverage for new vaccines.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2013-2637
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2014
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  • 3
    Online Resource
    Online Resource
    Adoption of Serogroup B Meningococcal Vaccine Recommendations
    American Academy of Pediatrics (AAP) ; 2018
    In:  Pediatrics Vol. 142, No. 3 ( 2018-09-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 142, No. 3 ( 2018-09-01)
    Abstract: In 2015, the Advisory Committee on Immunization Practices recommended that 16- to 23-year-olds may be vaccinated with the serogroup B meningococcal (MenB) vaccine on the basis of individual clinical decision-making (Category B). We assessed the following among US pediatricians and family physicians (FPs): (1) practices regarding MenB vaccine delivery, (2) factors influencing a decision to recommend the MenB vaccine, and (3) factors associated with discussing the MenB vaccine. METHODS: We surveyed a nationally representative sample of pediatricians and FPs via e-mail and Internet from October 2016 to December 2016. RESULTS: The response rate was 72% (660 of 916). During routine visits, 51% of pediatricians and 31% of FPs reported always or often discussing MenB vaccine. Among those who discussed often or always, 91% recommended vaccination; among those who never or rarely discussed, 11% recommended. We found that 73% of pediatricians and 41% of FPs currently administered the MenB vaccine. Although many providers reported not knowing about factors influencing recommendation decisions, MenB disease outbreaks (89%), disease incidence (62%), and effectiveness (52%), safety (48%), and duration of protection of MenB vaccine (39%) increased the likelihood of recommendation, whereas the Category B recommendation (45%) decreased likelihood. Those somewhat or not at all aware of the MenB vaccine (risk ratio 0.32 [95% confidence interval 0.25–0.41]) and those practicing in a health maintenance organization (0.39 [0.18–0.87] ) were less likely, whereas those aware of disease outbreaks in their state (1.25 [1.08–1.45]) were more likely to discuss MenB vaccine. CONCLUSIONS: Primary care physicians have significant gaps in knowledge about MenB disease and the MenB vaccine, and this appears to be a major driver of the decision not to discuss the vaccines.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2018-0344
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2018
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  • 4
    Online Resource
    Online Resource
    Physician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule
    American Academy of Pediatrics (AAP) ; 2015
    In:  Pediatrics Vol. 135, No. 4 ( 2015-04-01), p. 666-677
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 135, No. 4 ( 2015-04-01), p. 666-677
    Abstract: To assess among US physicians (1) frequency of requests to spread out recommended vaccination schedule for children & lt;2 years, (2) attitudes regarding such requests, and (3) strategies used and perceived effectiveness in response to such requests. METHODS: An e-mail and mail survey of a nationally representative sample of pediatricians and family physicians from June 2012 through October 2012. RESULTS: The response rate was 66% (534 of 815). In a typical month, 93% reported some parents of children & lt;2 years requested to spread out vaccines; 21% reported ≥10% of parents made this request. Most respondents thought these parents were putting their children at risk for disease (87%) and that it was more painful for children (84%), but if they agreed to requests, it would build trust with families (82%); further, they believed that if they did not agree, families might leave their practice (80%). Forty percent reported this issue had decreased their job satisfaction. Most agreed to spread out vaccines when requested, either often/always (37%) or sometimes (37%); 2% would often/always, 4% would sometimes, and 12% would rarely dismiss families from their practice if they wanted to spread out the primary series. Physicians reported using a variety of strategies in response to requests but did not think they were effective. CONCLUSIONS: Virtually all providers encounter requests to spread out vaccines in a typical month and, despite concerns, most are agreeing to do so. Providers are using many strategies in response but think few are effective. Evidence-based interventions to increase timely immunization are needed to guide primary care and public health practice.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2014-3474
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2015
    detail.hit.zdb_id: 1477004-0
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  • 5
    Online Resource
    Online Resource
    HPV Vaccine Delivery Practices by Primary Care Physicians
    American Academy of Pediatrics (AAP) ; 2019
    In:  Pediatrics Vol. 144, No. 4 ( 2019-10-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 144, No. 4 ( 2019-10-01)
    Abstract: To examine, among pediatricians and family physicians (FPs) (1) human papillomavirus (HPV) vaccine delivery practices, (2) delivery experiences, and (3) attitudes regarding new 2-dose HPV vaccination schedules. METHODS: We surveyed nationally representative networks of pediatricians and FPs by Internet or mail from July 2018 to September 2018. Multivariable regression was used to assess factors associated with refusal or deferral rates of ≥50% among 11- to 12-year-old patients. RESULTS: The response rate was 65% (302 pediatricians and 228 FPs included). Pediatricians who strongly recommended the HPV vaccine ranged from 99% for patients ≥15 years old (female) to 83% for those 11 to 12 years old (male); FPs ranged from 90% for patients ≥15 years old (female) to 66% for those 11 to 12 years old (male) (P & lt; .0001 between specialties). Sixty-five percent of pediatricians and 42% of FPs always or almost always used presumptive style when discussing the HPV vaccine (P & lt; .0001). Overall, 40% used standing orders and 42% had electronic alerts. Among pediatricians, the proportion reporting a refusal or deferral rate ≥50% was 19% for female patients and 23% for male patients 11 to 12 years old; FPs reported 27% and 36%, respectively. In the multivariable regression (both sexes), refusal or deferral was associated with physicians not strongly recommending the HPV vaccine to 11- to 12-year-old patients, not using a presumptive style, perceiving less resistance when introducing the HPV vaccine to a 13-year-old patient versus an 11- or 12-year-old patient, and anticipating an uncomfortable conversation when recommending the HPV vaccine to an 11- or 12-year-old patient. Eighty-nine percent of pediatricians and 79% of FPs reported that more adolescents & lt;15 years old are completing the HPV series now that only 2 doses are recommended. CONCLUSIONS: Although most physicians strongly recommend the HPV vaccine to 11- to 12-year-old patients, our data reveal areas for improvement in recommendation and delivery methods. Most physicians perceive that the 2-dose schedule is resulting in higher HPV completion rates.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2019-1475
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2019
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  • 6
    Online Resource
    Online Resource
    Pediatricians’ Experiences With and Perceptions of the Vaccines for Children Program
    American Academy of Pediatrics (AAP) ; 2020
    In:  Pediatrics Vol. 145, No. 3 ( 2020-03-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 145, No. 3 ( 2020-03-01)
    Abstract: The Vaccines for Children Program (VFC) provides vaccines for children who may not otherwise be vaccinated because of financial barriers. Pediatrician participation is crucial to the VFC’s ongoing success. Our objectives were to assess, among a national sample of pediatricians, (1) VFC program participation, (2) perceived burden versus benefit of participation, and (3) knowledge and perception of a time-limited increased payment for VFC vaccine administration under the Patient Protection and Affordable Care Act. METHODS: An electronic and mail survey was conducted from June 2017 to September 2017. RESULTS: Response rate was 79% (372 of 471); 86% of pediatricians reported currently participating in the VFC; among those, 85% reported never having considered stopping, 10% considered it but not seriously, and 5% seriously considered it. Among those who had considered no longer participating (n = 47), the most commonly reported reasons included difficulty meeting VFC record-keeping requirements (74%), concern about action by the VFC for noncompliance (61%), and unpredictable VFC vaccine supplies (59%). Participating pediatricians rated, on a scale from −5 (high burden) to +5 (high benefit), their overall perception of the VFC: 63% reported +4 or +5, 23% reported +1 to +3, 5% reported 0, and 9% reported −1 to −5. Of pediatricians, 39% reported awareness of temporary increased payment for VFC vaccine administration. Among those, 10% reported that their practice increased the proportion of Medicaid and/or VFC-eligible patients served on the basis of this change. CONCLUSIONS: For most pediatricians, perceived benefits of VFC participation far outweigh perceived burdens. To ensure the program’s ongoing success, it will be important to monitor factors influencing provider participation.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2019-1207
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2020
    detail.hit.zdb_id: 1477004-0
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