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Availability of free vaccines affects clinicians' decisions about referring uninsured children to public clinics

The Federal Vaccines for Children Program (VFC) provides States with free vaccines that are distributed to both private providers and public clinics for use in immunizing poor children. A 1997 survey of pediatric nurse practitioners (PNPs) found that PNPs who received free vaccine supplies were less likely than those who did not to refer children to public clinics for vaccinations. Eight percent of PNPs who received vaccines compared with 7 percent who did not receive them referred a privately insured child to a public clinic, 10 percent vs. 27 percent referred a Medicaid-insured child, and 46 percent vs. 67 percent referred an uninsured child to a public clinic.

These results are similar to a 1995 survey of physicians. In 1997, 82 percent of PNPs received free vaccines compared with only 52 percent of physicians in 1995. PNPs estimated that vaccination costs deterred only about 1 percent of children from receiving immunizations at the appropriate age. They estimated that a median of 10 percent of children in their practices received more than half of their vaccines from a health department or public clinic. Most (86 percent) of the PNPs in this study who were participating in the VFC program said they were very satisfied with the program.

Although referring children from primary care offices to public vaccine clinics is preferable to not vaccinating them, there are disadvantages. First, a child may visit the public vaccine clinic later and thus have a greater window of time when he or she is not age-appropriately vaccinated and thus is susceptible to diseases that can be prevented. Second, fragmentation of care occurs, with an increased burden and expense for the parents of taking the child to one site for vaccines and another site for well-child care and other services.

Also, medical records may not be easily transferred from one site to another, note Richard Kent Zimmerman, M.D., M.P.H., and his University of Pittsburgh colleagues. Their survey, which was supported by the Agency for Healthcare Research and Quality (HS09527), included telephone interviews with a national random sample of primary care PNPs.

See "Does the Vaccines for Children Program influence pediatric nurse practitioner referral of disadvantaged children to public vaccine clinics?" by Dr. Zimmerman, Susan N. VanCleve, M.S.N., Anne R. Medsger, R.N., M.S.Hyg., and others, in the Maternal and Child Health Journal 4(1), pp. 53-58, 2000.

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