Pediatrician and Family Physician Agreement with and Adoption of Universal Hepatitis B Immunization

Background: The purpose of this study was to assess (1) rates of agreement with and adoption of the universal hepatitis B vaccine recommendation among practicing pediatricians and family physicians in nine selected states; (2) physicians' attitudes related to hepatitis B immunization; and (3) physicians' perceptions of parental attitudes regarding the hepatitis B vaccine series.

Methods: Self-administered questionnaires were mailed to 3014 pediatricians and family physicians in selected metropolitan areas and non-metropolitan areas of nine states. Outcome variables were agreement with and adoption of the hepatitis B vaccine recommendation. Predictor variables included physicians' characteristics, practice type and location, and proportion of managed care and Medicaid patients. Other variables that were studied include physicians' attitudes related to hepatitis B immunization, sources of immunization recommendation information, personal completion of the hepatitis B immunization series, and physicians' impressions of parental attitudes about the vaccine.

Results: Pediatricians were more likely than family physicians to report that they knew "a lot" about the recommendation (95% vs 84%), agreed with it (83% vs 57%), and have adopted it into practice (90% vs 64%). More physicians in both specialties had adopted the recommendation than actually agreed with it. Doubt about long-term protection from the vaccine was a strong predictor of not agreeing with or adopting the recommendation. Parental resistance to or request for hepatitis B vaccine affected the likelihood of physicians adopting it.

Conclusions: Pediatricians and family physicians continue to differ in both agreement with and adoption of universal hepatitis B immunization. Two years after the recommendation was made, less than two thirds of all family physicians have adopted this recommendation. Adoption is likely influenced by practice policy, physician attitudes, and perceived parental opinions. We recommend that as new vaccines are approved and recommended, research be conducted to explore and address issues germane to physician agreement and adoption.