Immunization practices in physicians' offices on the Avalon Peninsula of Newfoundland

by O'Keefe, Catherine

The immunization needs in Newfoundland and Labrador are currently met through a Mxed delivery system. Immunkation is performed through the Regional Health and Cornmunity SeMces offices, approxhately 60% and private practice physicians, approximately 40%. This study assessed irnmunization practices in private physicians' offices with a focus on storage, handling and documentation compared with National Advisory Cornmittee on Immunkation (NACI) Guidelines. One of the key aspects of storage and handihg is the maintenance of the cold chah The cold chah is the process of maintaining vaccine at the optimum temperature fkom the tirne it is manufactured until it is administered. Since the inception of the cold chah concept, methods to assess and promote proper vaccine storage and handling have been developed. This study has a quasi-experimental, pre and post intervention design. The study group consisted of solo and group private practice physicians who provide childhood immunizations in urban and rural practices on the Avalon Peninsula in the Province of Newfoundland and Labrador. Starting in March 1998, the researcher contacted 37 offices representing 89 physicians to participate in the study. The study consisted of an office visit during which information was coflected concerning the practice for handling vaccine. This informationwas coilected tbrough a questionnaire, observation of the storage area and documentation of the refngerator temperature. The intervention hcluded the provision and discussion of National and Provincial guidelines for storage and handling of vaccine. A second visit six to eight months later assessed change in practice post intervention. Of the 37 available offices, 27 (73%) participated in the study representing 89 physicians; al offices visited met at least 18 of the 24 guidelines. Vaccine was stored in the body of a refkigerator in 95% of the participating offices, 37% of the offices had a thennometer in the refkigerator, and Iess than 20% used thermal transport bags. Documenting the refngerator temperature on a regular basis was only done in one office. Post intervention visits indicated Little change in practice. This study has collected baseline data about physicians' practices and has given some data as to what is effective in encouraging physicians to maintain the cold chah