DIFFUSION AND ADOPTION OF CHILDREN'S VACCINE GUIDELINES. Even though pediatric vaccines have been instrumental in reducing infectious diseases among U.S. children, up to 40% of two-year olds currently do not receive immunizations on schedule. Recent epidemics of vaccine preventable diseases underscore the public health significance of incomplete vaccine coverage. Although limitations in physician access by some children partially explain why many are not immunized, physicians' noncompliance with recommended vaccine guidelines also contributes to this problem. Federal health policy aims to increase to 90% the proportion of primary care providers offering immunization series on time. However, rapid development of newer vaccines and proliferating recommendations threatens to further increase physicians' uncertainty of """"""""appropriate vaccine practices. Longer lag times likely will occur in the adoption of newer vaccines. Little is known about how new vaccine guidelines from governmental and professional authoritative bodies can be crafted and disseminated so as to be maximally noted, accepted, and adhered to by physicians. This study will: (1) identify pediatricians' and family physicians' current awareness of, agreement with, adoption of, and adherence to immunization guidelines for selected pediatric diseases; (2) identify correlates of pediatric vaccine guideline awareness, acceptance, adoption, and adherence, including physician specific, practice specific and environmental factors; (3) identify features of immunization guidelines themselves and their routes of dissemination that influence their visibility and adherence rates by physicians; (4) identify physician perceived barriers to the successful dissemination and implementation of vaccine guidelines, and (5) develop strategies to (a) more effectively craft and disseminate vaccine guidelines to increase their visibility and acceptance by physicians, and (b) to maximize practices' ability to achieve high administration rates for vaccines they adopt. Understanding the intricacies of successful vaccine guideline dissemination will add to national efforts to learn how to more effectively disseminate clinical practice guidelines in other clinical areas. This three year, multi-phase study will be conducted by a team of physicians, social scientists and statisticians. Data will be gathered through: (1) a mail survey of a nationally representative sample of 1000 pediatricians, family physicians, and general practitioners, with a subsequent follow-up mail survey of all respondents 18 months later, (2) office record audits of a 10% sample of these physicians, (3) six focus groups of 'high"""""""" and """"""""low' vaccine guideline compliers, and (4) telephone contacts with schools and health departments local to the study physicians.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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VA Health Services Research and Development Scientific Merit Review Board (HSRD)
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University of North Carolina Chapel Hill
Schools of Medicine
Chapel Hill
United States
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Freed, G L; Katz, S L (1993) The Comprehensive Childhood Immunization Act of 1993. N Engl J Med 329:1957-60