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Gaps Between Knowledge and Action Among Family Practice Physicians and Pediatricians in Washington State, 1998

James A. Gaudino, MD, MS, MPH; M. Patricia deHart, ScD; Allen Cheadle, PhD; Diane P. Martin, PhD; Danna L. Moore, PhD; Sheryl J. Schwartz, MPA; Beryl Schulman, PhD

Arch Pediatr Adolesc Med. 2002;156:978-985.

Objectives  To assess the availability and use of Washington State's CHILD (Children's Health, Immunization, Linkages, and Development) Profile and other computerized immunization tracking systems, to determine physicians' attitudes about these systems, and to identify factors associated with using them.

Design  Randomized, population-based, cross-sectional survey.

Participants  Washington family physician and pediatrician specialty organization members providing childhood immunizations in 1998 (N = 2472).

Main Outcome Measure  Reported CHILD Profile and other computerized systems use.

Results  The adjusted response rate was 75% (n = 1331). Overall, 37.7% of respondents had heard of CHILD Profile, 6.3% used it, and 24.9% used other systems. Groups significantly more likely not to use computerized systems than referent pediatricians in areas fully implementing CHILD Profile were family physicians (adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.0), private physicians (aOR, 8.0; 95% CI, 3.2-20.1), physicians taking fewest opportunities to immunize (aOR, 2.3; 95% CI, 1.4-3.7), and physicians practicing in local health jurisdiction areas with CHILD Profile marketing activity (aOR, 2.1; 95% CI, 1.2-3.9) or in those areas with little or no registry activity (aOR, 2.6; 95% CI, 1.6-4.4). Those with systems agreed that they save time (71.0%), make status checks easier (87.1%), and increase immunization coverage (88.6%). Those without systems agreed that they help practices (90.3%) and increase efficiency (76.5%), but fewer agreed that they reduce costs (30.2%).

Conclusions  Although most physicians agreed that computerized systems are useful, few had them or used them. Provider-based systems can improve immunization coverage, but the feasibility and effectiveness of communitywide and statewide systems remain unexplored. Because these systems depend on participation, more understanding is needed to help organizations implement them. Interventions to increase availability and use should address provider and health organization needs.

From the Maternal and Child Health Programs, Community and Family Health, Department of Health, State of Washington, Olympia (Drs Gaudino and deHart); the Pregnancy and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Gaudino); the Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle (Drs Cheadle, Martin, and Schulman and Ms Schwartz); and the Social and Economic Sciences Research Center, Washington State University, Pullman (Dr Moore). Dr Gaudino was affiliated with the Maternal and Child Health Programs during the study period.

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