Biomedical subjects

R K Zimmerman

Publications and source records attributed to R K Zimmerman.

59 records · Page 4Linked to original sources

PubMedDate not supplied

Knowledge and attitudes of Minnesota primary care physicians about barriers to measles and pertussis immunization.

BACKGROUND: Understanding the causes of low levels of childhood immunization is critical to preventing outbreaks of vaccine-preventable diseases. Hence, we examined physicians' knowledge and attitudes about measles and pertussis vaccines and barriers to immunization. METHODS: We developed a telephone questionnaire, subjected it to a pilot test, and subsequently interviewed Minnesota pediatricians, general practitioners, rural family physicians, and urban family physicians. The physicians were selected by a random process. RESULTS: The response rate was 76.4 percent (411 of 538 eligible physicians). Almost all physicians thought that vaccine efficacy was high and that the likelihood of serious side effects was low. Respondents were divided, however, about the likelihood of serious complications from pertussis disease and the role of adults as a pertussis reservoir. Many physicians inappropriately believed certain conditions were contraindications to vaccination; for instance, 33 percent of physicians would not administer measles, mumps, and rubella vaccine to a child whose mother was pregnant. Many physicians (31 percent) would not administer four vaccines simultaneously because of concerns that included parental acceptance and vaccine efficacy. Physicians were more likely to refer children without insurance (P < 0.001) or with Medicaid (P < 0.001) than children with insurance to health department vaccine clinics for immunization. CONCLUSIONS: For immunization rates to reach high levels, changes are needed in health care system issues, such as vaccine reimbursement, and in provider practices, such as interpretation of vaccine contraindications.

Family Practice↗

PubMedDate not supplied

Immunization barriers in a family practice residency clinic.

BACKGROUND: Underimmunization was the primary cause of the 1990 measles outbreak in the United States. We examined the level and causes of underimmunization in a family practice residency clinic that received free vaccine supplies from the county health department. METHODS: The office computer selected 286 patients aged 2 to 3 years. From these 286 patients, 175 were sampled. Their charts were audited for immunization barriers, looking specifically for (1) valid reasons; (2) overly cautious interpretation of contraindications, especially minor illnesses; (3) missed opportunities (failure to address immunization status during acute care visits or lack of simultaneous vaccine administration); (4) parental refusal; and (5) delayed immunizations resulting from gaps in clinic attendance. RESULTS: There were 174 delayed doses; 90 were due to gaps in clinic attendance, 42 due to valid reasons, 33 due to invalid contraindications, and 25 due to missed opportunities. Some doses were delayed on more than one occasion and for more than one reason. Two parents refused initial immunizations, claiming that the children were too small. CONCLUSION: Important causes of delayed immunizations in this residency clinic were gaps in attendance, overly cautious interpretations of contraindications, missed opportunities, and lack of simultaneous vaccine administration.

Appointments and Schedules↗

PubMedDate not supplied

Pertussis, pertussis vaccine, and care of exposed persons.

BACKGROUND: Pertussis is a highly contagious bacterial infection caused by Bordetella pertussis. Before routine vaccination against pertussis was available, most persons were infected during childhood. After widespread vaccination, however, the incidence of pertussis in the United States dropped by more than 95 percent, though localized outbreaks continue to occur. METHODS: A multidisciplinary team developed a set of review articles as part of continuing medical education modules in the Teaching Immunization in Medical Education (TIME) Project. The team developed the materials using expert judgment and selected materials from the literature and the Centers for Disease Control and Prevention (CDC). The first step was the creation of specific learning objectives that used the spectrum of Bloom's taxonomy, when possible. After the materials were developed, they were pilot-tested and revised. Subsequently they underwent summative evaluation by field-testing the materials with 24 other primary care physicians. Then the materials were reviewed by the CDC and national vaccine experts and revised based on their comments. RESULTS AND CONCLUSIONS: The efficacy of whole-cell pertussis vaccine is about 70 to 90 percent, though local adverse events are common. Since 1990 several purified, acellular pertussis vaccines have been developed that have one quarter to one half of the common adverse events associated with whole-cell vaccine and have similar efficacy rates. The incidence of pertussis can be further reduced by increasing age-appropriate vaccination rates.

Child↗

PubMedDate not supplied

Development and multicenter evaluation of Multistation Clinical Teaching Scenarios on immunization: the ATPM-CDC Teaching Immunization for Medical Education (TIME) Project.

INTRODUCTION: The objective of this project was to develop and evaluate case-based immunization education materials that use a new teaching method called Multistation Clinical Teaching Scenarios (MCTS) for use in medical school clerkships and primary care residencies. METHODS: A multidisciplinary team developed objectives, abstracted clinical cases, and created MCTS modules, which use contextual learning, problem solving, and small-group interaction. RESULTS: Mean scores increased from the 10-item pretest to the posttest by 3.2 (95% confidence interval [CI] of 2.8 to 3.6) items for measles, 3.8 (CI = 3.4 to 4.1) for influenza, and 1.8 (CI = 1.4 to 2.1) for hepatitis B (P < .01 for each). To evaluate the materials, we administered questionnaires and conducted focus groups. Most (99%) of the students and residents rated the materials highly, as did most (89%) facilitators. CONCLUSIONS: This new method has been widely tested, increases content mastery, and is well received.

Clinical Clerkship↗

PubMedDate not supplied

Barriers to measles and pertussis immunization: the knowledge and attitudes of Pennsylvania primary care physicians.

OBJECTIVES: To understand the causes of low childhood immunization rates, physicians were interviewed about their knowledge, attitudes, and self-reported immunization practices. METHODS: Trained interviewers conducted a standardized telephone survey of physicians. A random sample of Pennsylvania family physicians, pediatricians, and general practitioners younger than 65 years of age who were in office-based practices was selected from the combined listings of the American Medical Association and American Osteopathic Association. Physicians seeing > or = 5 patients per week under age 6 years, seeing a total of > or = 15 patients per week, and having > or = 50% primary care patients were eligible. Of 383 eligible physicians, 70% (268) responded. The questionnaire was designed using the Health Belief Model, immunization barriers, and input from practitioners in primary care, pediatric infectious disease, maternal/ child health, and preventive medicine. RESULTS: Respondents were more likely to refer to public vaccine clinics those children without insurance (P < .001) or with Medicaid (P < .001) than children with insurance. Almost all (> 90%) respondents thought that vaccine efficacy was high and that the likelihood of serious side effects was low. However, only 37% gave estimates that corresponded with the literature regarding the likelihood of an infant with pertussis to need hospitalization. Many respondents used invalid vaccine contraindications; for instance, 37% would not administer MMR to a boy whose mother was pregnant. Many respondents (21%) would not administer four vaccines simultaneously. CONCLUSIONS: If the Healthy People 2000 goal to eliminate indigenous cases of measles is to be achieved, free vaccine supplies and increased provider education are needed.

Attitude of Health Personnel↗