Objective: To assess the impact of continuity of care on immunization coverage in minority communities.
Methods: In 4/97 and 4/98, we audited the medical records of 858 randomly selected children 6-11 months of age at 11 primary care practices in a low-income, minority community in New York City. In 4/99, we re-audited the records for these children, now aged 18 to 35 months. Children who moved or gone elsewhere (4.5%) were excluded. Up-to-date status was assessed for DTP/Polio/MMR/Hib (4-3-1-3). Parallel records for these children were obtained from the New York Citywide Immunization Registry. Active patients had visited the practice in the last six months.
Results: Of the original cohort, 40.9% of the children were still active at the primary practice. Based on medical record audits, coverage rate was 89.2%, compared to 41.6% for children no longer active (OR=11.6, 95% CI=7.9-16.9). When registry records were included, coverage rose by 4% to 93.2% for children still active (t=3.81, p <0.001) and by 15% to 56.2% for children no longer active. (t=9.30, p<0.001). Children active in the practice were 10.6 times more likely to be up-to-date than children no longer active (95% CI=6.8–6.6). Half (51.5%) of the children active at the primary practice received immunizations at secondary providers, compared with 40.7% of the children no longer active.
Conclusions: Although most of these urban minority children used secondary providers for immunizations, immunization outcomes were superior for children maintaining continuity of primary care throughout the second year of life.
Learning Objectives: To understand the relationship between continuity of primary care and immunization outcomes.
Keywords: Immunizations,
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.