CHANGING IMMUNIZATION REFERRAL PATTERNS AMONG PEDIATRICIANS AND FAMILY-PRACTICE PHYSICIANS, DALLAS COUNTY, TEXAS, 1988

Family practice physicians and pediatricians in Dallas County, Texas, were surveyed to determine how recent vaccine price increases have changed immunization referral patterns. A total of 73% of responding physicians referred some pediatric patients for immunization in 1988. Public health clinics were the largest referral source with more responding pediatricians (84.4%) referring patients than did responding family practitioners (66.5%). Referrals to the clinics were most often made when patients were unable to afford immunizations in a private practice setting. Between 1979 and 1988, the number of responding pediatricians and family practitioners making immunizations referrals increased by 193% and 391%, respectively. The percentages of children referred for immunization increased by 693% during the same decade. It was suggested by our survey of Dallas County physicians that a new influx of patients are using public sector immunizations, potentially creating additional financial stress for public health programs. In addition, this shift to the public sector may undermine the health departments' ability to provide new vaccines or protect greater numbers of children with immunization.