Missed opportunities in preventive pediatric health care. Immunizations or well-child care visits?

Abstract

Objective: To determine the percentage of patients in a large pediatric practice in compliance with national recommendations regarding immunizations and well-child care visits.

Research design: Chart review. Point estimates with 95% confidence intervals were determined for reviewed charts in compliance with recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention and schedule of well-child care visits, screening, and anticipatory guidance recommended by the American Academy of Pediatrics (AAP).

Setting: A large, multisite urban public pediatric practice.

Patients: Three hundred eighty-six infants and children (aged 0 to 60 months) who had a total of 7595 patient visits.

Selection procedure: A random sample of charts.

Results: There was a large discrepancy in compliance for patients aged 0 to 23 months in ACIP-recommended immunizations (90.5% +/- 3.9%) vs AAP-recommended well-child care visits (37.6% +/- 6.4%) and for patients aged 24 to 60 months in ACIP-recommended immunizations (87.8% +/- 5.1%) vs AAP-recommended well-child care visits (31.0% +/- 7.1%).

Conclusions: The data suggest that immunization alone does not ensure that children will receive all aspects of preventive care, raising questions about the practicality of the current AAP recommendations for preventive pediatric health care.