1861. Characteristics of Physicians Who Dismiss Families for Refusing Vaccines
Session: Poster Abstract Session: Vaccines: Improving Immunization Uptake
Saturday, October 10, 2015
Room: Poster Hall
Background: Physicians’ dismissing families who refuse vaccines from their practices is controversial. We assessed among pediatricians (Peds) and family physicians (FP): 1) reported prevalence of parental refusal of one or more vaccines in the infant series; 2) physician response to refusal; 3) the association between often/always dismissing families and provider/practice characteristics and state exemption laws.

Methods: Nationally representative survey conducted 6/2012-10/2012. A multivariable analysis assessed association of often/always dismissing families with physician/practice characteristics, state philosophical exemption policy, and degree of difficulty obtaining exemptions.

Results: The response rate was 66% (534/815). Overall, 83% of physicians reported that in a typical month, ≥1% of parents refused one or more infant vaccines, and 20% reported that >5% of parents refused.  Fifty-one percent reported always/often requiring parents to sign a form if they refused (Peds 64%, FP 29%, p<0.0001); 21% of Peds and 4% of FP reported always/often dismissing families if they refused ≥1 vaccine. Forty-three percent of Peds reported dismissing families at least some of the time. Peds only were further analyzed because few FP dismissed families. In bivariate analysis, in states where philosophical exemptions are allowed, only 9% of Peds report dismissing families for refusing vaccines in the infant series versus 34% in states that do not allow philosophical exemptions (p<0.0001).  In multivariable analysis, Peds who dismissed families were more likely to be in private practice (Adjusted OR (AOR) 4.90, 95% CI 1.40-17.19), from the South (AOR 4.07, 95% CI 1.08-15.31), and reside in a state without a philosophical exemption law (AOR 3.70, 95% CI 1.74-7.85). There was no association with degree of difficulty in obtaining exemptions.

Conclusion: Almost all physicians encounter parents who refuse infant vaccines. One-fifth of Peds report dismissing families who refuse, but there is substantial variation in this practice. Given the frequency of dismissal, the impact of this practice on vaccine refusers and on pediatric practices should be studied.

Sean O'leary, MD, MPH1, Mandy Allison, MD, MSPH2, Lori Crane, PhD, MPH3, Brenda Beaty, MSPH4, Laura Hurley, MD, MPH5, Michaela Brtnikova, PhD6, Andrea Jimenez-Zambrano, MPH6 and Allison Kempe, MD, MPH7, (1)Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (2)Pediatrics, University of Colorado, Aurora, CO, (3)Colorado School of Public Health, Aurora, CO, (4)Colorado Health Outcomes Research, University of Colorado Anschutz Medical Campus, Aurora, CO, (5)Denver Health, Denver, CO, (6)Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, CO, (7)Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO

Disclosures:

S. O'leary, None

M. Allison, None

L. Crane, None

B. Beaty, None

L. Hurley, None

M. Brtnikova, None

A. Jimenez-Zambrano, None

A. Kempe, None

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