Factors Influencing Immunization Status in Primary Care Clinics

Background and Objectives: National standards and goals for childhood immunization rates are well established. Yet, despite clear standards and goals, physicians do not achieve the desired rate (90%) for immunization coverage. This study examined factors related to immunization status for 2-year-old children in pediatric and family practice settings. Methods: Specially trained personnel used computer software to audit 2,552 records from 42 practices in Northeast Florida throughout 1997–1999. Immunization records were judged as either complete or incomplete, and factors related to immunization status were studied. Clinic type and 18 immunization practice standards were reviewed for effect on immunization status. Results: The probability of complete immunization status for children in pediatric clinics was greater than for those in family practice clinics. Multivariate logistic regression revealed that use of semiannual audits (odds ratio [OR]=2.00, confidence interval [CI]=1.65–2.42) was the most important factor for immunization completion. This was followed by availability of discounted immunizations (OR=.44, CI=.27–.73) and the use of an immunization tracking system (OR=1.48, CI=1.18–1.70). Factors that were not found to contribute included clinic type and the remaining 15 practice standards. Conclusions: Considering the significant factors, immunization status was not affected by the type of clinic providing immunizations. Based on this analysis, family physicians should implement tracking systems and should perform semiannual audits to match the success of pediatricians in immunizing children. Neither group met nationally established goals for administration of immunizations for 2-year-old children

Chikungunya Virus: A Rising Health Risk in the United States and How Nurse Practitioners Can Help Address and Reduce the Risk

Chikungunya virus (CHIKV) is not widely known or understood in the United States, although it is rapidly increasing in its global reach and prevalence. Most nurse practitioners and other medical staff have never seen a case of CHIKV, and its similarities to other viruses may cause it to be overlooked. However, the chronic effects and worldwide spread of this virus require us to become familiar with CHIKV, how it spreads, and what prevention and treatment options are available. This article summarizes the history, symptoms, diagnosis, and treatments for CHIKV and offers guidelines for nurse practitioners to promote education and prevention