Time for Changes in Immunization

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Commentary

Time for Changes in Immunization

J Fam Pract. 1999 August;48(8):588-589

References

1. Kimmel SR, Puczynski S, McCoy RC, Puczynski MS. Practices of family physicians and pediatricians in administering poliovirus vaccine. J Fam Pract 1999;48:594-600.

2. Freed GL, Bordley WC, Clark SJ, et al. Universal hepatitis B immunization of infants: reactions of pediatricians and family physicians over time. Pediatrics 1994;93:747-51.

3. Zimmerman RK, Mieczkowski TA. How important is early childhood hepatitis B vaccination: a survey of primary care physicians. J Fam Pract 1998;47:370-4.

4. Centers for Disease Control. Certification of poliomyelitis eradication: the Americas, 1994. MMWR Morb Mortal Wkly Rep 1994;43:720.-

5. Centers for Disease Control and Prevention. Progress toward global eradication of poliomyelitis. MMWR Morb Mortal Wkly Rep 1997;46:579-84.

6. Centers for Disease Control and Prevention. Poliomyelitis prevention in the United States: introduction of a sequential vaccination schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 1997;46(No. RR-3):1-25.

7. Centers for Disease Control and Prevention. Epidemiology & prevention of vaccine-preventable diseases: the pink book. 4th ed. Atlanta, Ga: Centers for Disease Control and Prevention; 1997.

8. Thoms ML, Bodnar PZ, O’Donovan JC, et al. Parental knowledge and choice regarding live and inactivated poliovirus vaccines. Arch Pediatr Adolesc Med 1997;151:809-12.

9. Desai S, Kolasa M, Bisgard K, et al. Is the new poliovirus immunization recommendation acceptable to parents? Abstracts of the 32nd National Immunization Conference, Atlanta, Ga, July 21-24, 1998.

10. American Academy of Pediatrics Committee on Infectious Diseases. Poliomyelitis prevention: recommendations for use of inactivated poliovirus vaccine and live oral poliovirus vaccine. Pediatrics 1997;99:300-5.

11. Zimmerman RK, Spann SJ. Poliomyelitis vaccine options. Am Fam Physician 1999;59:113-20.

12. Peter G, ed. Red book: report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1997;1-764.

13. Zimmerman RK, Schlesselman JJ, Baird AL, et al. A national survey to understand why physicians limit childhood immunizations. Arch Pediatr Adolesc Med 1997;151:657-64.

Family physicians and pediatricians should differ for several reasons. For instance, specialty differences start in training, as most family practice residencies are based in community hospitals and emphasize outpatient medicine, while many pediatric residencies are based in tertiary care institutions with a greater emphasis on inpatient treatment. Following residency training the specialties differ again, with family physicians usually starting in practice, often in small towns, while many pediatricians pursue fellowships. The history of family medicine as a specialty that emphasizes outpatient medicine and the physician-patient relationship leads naturally to less emphasis on the judgment of a tertiary care specialist and more on shared decisions that reflect the patient’s values and economic situation. Immunization information sources also vary by specialty. Most pediatricians (74%) rate the Red Book¹² the most important source for information, while family physicians cite a variety of sources: journals (44%), Red Book (34%), health department (11%), colleagues (5%), and others (6%).¹³

I believe that more timely in-depth dissemination of information on immunizations is needed for family physicians. Family physicians do differ from pediatricians, however, so the development of tools for delivering this information to family physicians is needed. There are many reasons why now is the time for a detailed and evidence-based text on immunizations across the life span by family physicians for family physicians:

A cadre of experienced educators, clinicians, and researchers now exists within family medicine that can make sound evidence-based decisions (ie, the Group on Immunization Education in the Society of Teachers of Family Medicine and the Commission on Clinical Policies and Research in the AAFP).
The AAFP took the lead in immunizations by being the first national organization to recommend routine influenza vaccination at age 50, a cost-effective recommendation that is supported by solid medical evidence.
Family physicians who treat patients across the life span differ from physicians of other specialties and often partner with patients in decision making.
Family physicians lack a single definitive text on immunizations and lack consensus on where to turn for this information.
The immunization texts of other specialties lack family physician input and perspective.
The immunization field is changing rapidly and will continue to do so.

To be successful, this text will need strong support from our professional societies, since distributing it widely will be expensive, and keeping it current will require considerable effort. Kimmel and coworkers have shown us that beliefs and information dissemination differ by specialty. I believe that it is time for family medicine to take the next step with an immunization textbook by our professional societies.

Time for Changes in Immunization

References

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