BACKGROUND: When the Advisory Committee on Immunization Practices added the sequential schedule to the poliovirus vaccine (PW) recommendations in 1997, primary care physicians expressed concern about its implementation. This study examines the practices and factors influencing the administration of sequential, oral, or inactivated PW schedules by family physicians and pediatricians. METHODS: A random sample of Ohio family physicians and pediatricians was surveyed between January and April 1998. Primary outcome measures included physicians' awareness of the 1997 recommendations, their recommendations to parents and caregivers, administration of current PW options, and the factors influencing their practices. RESULTS: All physicians who immunize children (n = 263) reported awareness of the 1997 PW recommendations. Family physicians were more likely to recommend and administer oral polio vaccine than pediatricians (50% and 63% vs 17% and 28%; P < .001). Pediatricians were more likely to recommend and administer the sequential schedule than family physicians (66% and 67% vs 31% and 28%; P < .001). Choice of sequential schedule was related to the risk of vaccine-associated paralytic poliomyelitis and liability (P < or = .05). Choice of an all oral polio vaccine schedule was related to cost of inactivated PW and increased number of injections (P < or = .05). One hundred eighty-two physicians (69%) indicated that they personally discuss PW options with parents or caregivers; only 41% have them read the required vaccine information sheets. CONCLUSIONS: Differences exist between family physicians' and pediatricians' implementation of the 1997 PW recommendations. Physician choice of PW schedule is influenced by the risk of vaccine-associated paralytic poliomyelitis, increased number of injections, liability concerns, and vaccine cost. Physicians need to inform parents of vaccine benefits and risks to comply with federal regulations.
BACKGROUND: When the Advisory Committee on Immunization Practices added the sequential schedule to the poliovirus vaccine (PW) recommendations in 1997, primary care physicians expressed concern about its implementation. This study examines the practices and factors influencing the administration of sequential, oral, or inactivated PW schedules by family physicians and pediatricians. METHODS: A random sample of Ohio family physicians and pediatricians was surveyed between January and April 1998. Primary outcome measures included physicians' awareness of the 1997 recommendations, their recommendations to parents and caregivers, administration of current PW options, and the factors influencing their practices. RESULTS: All physicians who immunize children (n = 263) reported awareness of the 1997 PW recommendations. Family physicians were more likely to recommend and administer oral polio vaccine than pediatricians (50% and 63% vs 17% and 28%; P < .001). Pediatricians were more likely to recommend and administer the sequential schedule than family physicians (66% and 67% vs 31% and 28%; P < .001). Choice of sequential schedule was related to the risk of vaccine-associated paralytic poliomyelitis and liability (P < or = .05). Choice of an all oral polio vaccine schedule was related to cost of inactivated PW and increased number of injections (P < or = .05). One hundred eighty-two physicians (69%) indicated that they personally discuss PW options with parents or caregivers; only 41% have them read the required vaccine information sheets. CONCLUSIONS: Differences exist between family physicians' and pediatricians' implementation of the 1997 PW recommendations. Physician choice of PW schedule is influenced by the risk of vaccine-associated paralytic poliomyelitis, increased number of injections, liability concerns, and vaccine cost. Physicians need to inform parents of vaccine benefits and risks to comply with federal regulations.