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Physicians Most Likely to Dismiss Patients for Infant Vaccine Refusal

AURORA, CO – How often physicians “fire” parents who refuse infant vaccines varies considerably but appears to have some relationship to practice setting and state policy, according to a new study.

The study, published recently in the journal Pediatrics, notes that about 20% of pediatricians report dismissing families who refuse infant vaccinations, but there is substantial variation in how refusal is handled.

Because the practice of dismissal is controversial and discouraged by the American Academy of Pediatrics, a study team led by University of Colorado researchers sought to determine more about physicians who jettison patients over the issue.

Using a nationally representative survey conducted from June to October 2012, the researchers looked at pediatricians and family physician respondents, focusing on reported prevalence of parental refusal of one or more vaccines in the infant series, physician response to refusal and the association between often/always dismissing families and provider/practice characteristics and state exemption laws.

With an overall survey response rate of 66%, 534 out of 815, 83% of physicians reported that in a typical month, 1.0% or more of parents refused one or more infant vaccines, and 20% reported that more than 5% of parents refused. Of the 51% of respondents who reported that they always/often required parents to sign a form if they refused, the rate was much higher among pediatricians, 64%, than family physicians, 29%.

In terms of dismissing families if they refused one or more vaccinations, pediatricians were also more likely to do that than FPs – 21% vs. 4%.

The pediatricians who dismissed families were more likely to be in private practice. From the South and reside in a state without a philosophical exemption law.

“In states in which 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 , .0001),” study authors point out. “Twelve percent of physicians in states with an easy exemption process dismissed families, versus 22% in states with a medium exemption policy and 28% in states with a difficult exemption process.”

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