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Background. The purpose of this study was to assess (1) rates of agreement with and adoption of the universal hepatitis B vaccine recommendation among practicing pediatricians and family physicians in nine selected states; (2) physicians' attitudes relatcd to hepatitis B immunization; and (3) physicians' perceptions of parental attitudes regarding the hepatitis B vaccine series. Methods. Self-administered questionnaires were mailed to 3014 pediatricians and family physicians in selected metropolitan areas and non-metropolitan areas of nine states. Outcome variables were agreement with and adoption of the hepatitis B vaccine recommendation. Predictor variables included physicians' characteristics, practice type and location, and proportion of managed care and Medicaid patients. Other variables that were studied include physicians' attitudes related to hepatitis B immunization, sources of immunization recommendation information, personal completion of the hepatitis B immunization series, and physicians' impressions of parental attitudes about the vaccine. Results. Pediatricians were more likely than family physicians to report that they knew "a lot" about the recommendation (95% vs 84%), agreed with it (83% vs 57%), and have adopted it into practice (90% vs 64%). More physicians in both specialties had adopted the recommendation than actually agreed with it. Doubt about long-term protection from the vaccine was a strong predictor of not agreeing with or adopting the recommendation. Parental resistance to or request for hepatitis B vaccine affected the likelihood of physicians adopting it. Conclusions. Pediatricians and family physicians continue to differ in both agreement with and adoption of universal hepatitis B immunization. Two years after the recommendation was made, less than two thirds of all family physicians have adopted this recommendation. Adoption is likely influenced by practice policy, physician attitudes, and perceived parental opinions. We recommend that as new vaccines are approved and recommended, research be conducted to explore and address issues germane to physician agreement and adoption. key words. Hepatitis B vaccines; immunization; physicians' practice patterns; pediatricians; physicians, family. (J Fam Pract 1996; 42:587-592), Universal immunization of infants against hepatitis B was recommended in 1991 by the Advisory Committee on Immunization Practices (ACIP) of the United States Public Health Service.[1] In 1992, the Amerim [...]

This article is an exploration of the specific application of need-based and demand-based models for assessing health personnel supply requirements to the field of physical therapy. Definitions and examples of these models are offered. Problems presented in the field of physical therapy in accurately defining need and demand are presented. Specific examples of current data collection at a variety of levels (professional association, private sector, state, and federal) are given. [Hack LM, Konrad TR. Determination of supply and requirements in physical therapy: some considerations and examples. Phys Ther. 1995; 75:47--55.], Key Words: Health personnel, Health services research, Human resource planning, Physical therapy profession. Human resource planning in health care, what was called "health manpower planning," is concerned with projecting the [...]

Objective. This study inquires whether retention in rural practice settings is longer for graduates of public medical schools and community hospital-based residencies, and for those who participated in rural rotations as medical students and residents. These questions are addressed separately for "mainstream" rural physicians and physicians serving in the National Health Service Corps (NHSC). Design. Design is a prospective cohort study. Participants. Study subjects were 202 primary care physicians who graduated from U.S. allopathic medical schools from 1970-1980, and who in 1981 were working in a nationally representative sample of externally subsidized rural practices. Nearly half were serving in the NHSC. Physicians were first identified in 1981 as part of an earlier study. Intervention. In 1990, study subjects were relocated and sent a follow-up mail survey inquiring about their medical training backgrounds and their careers from the time of graduation until 1990. We examined associations between four features of physicians' medical training and their subsequent retention in rural practice settings. Results. Among those not in the NHSC, rural retention duration did not differ for those from public versus private medical schools, those who trained in community hospitals versus university hospital-based residencies, or for those who completed versus did not complete rural rotations as students or residents. Among NHSC physicians, no retention duration differences were noted for those with rural experiences as students or residents, or for those trained in community hospital residencies. Contrary to common wisdom, public school graduates in the NHSC remained in rural areas for shorter periods than private school graduates. Conclusions. These findings call into question whether current rural-focused medical education initiatives prepare rural physicians in ways able to influence their retention in rural settings. For purposes of enhancing the rural practice retention of its alumni, the NHSC should not selectively award scholarships to students from public medical schools. Keywords. Rural primary care physicians, rural health care, medical education, National Health Service Corps, The United States has struggled for many years with the problem of ensuring a sufficient supply of physicians for rural communities. To learn how to guide more physicians into rural [...]

Background. This cross-sectional study assessed physicians' satisfaction with the current insurance-based reimbursement system and preferences for the two most frequently discussed health care reform proposals, and estimated the association between [...]

Background. The incidence of hepatitis B infection has risen 37% over the last decade; 300,000 new infections and 5000 deaths occur annually in the United States. Because immunization programs that targeted high-risk groups failed to abate this increase, the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation to family physicians, (2) the effect of the new recommendation on clinical practice, and (3) the degree to which noneconomic barriers may affect adoption of universal hepatitis B immunization. Methods. A random sample of 300 family physicians in North Carolina was surveyed by mail. Descriptive statistics and chi-square analysis were used to assess the relationship of variables hypothesized to predict physician awareness of, and agreement with, the new recommendation. Results. The response rate was 78%. Overall, 48% of family physicians who administered immunizations to children were aware of the new hepatitis B vaccine recommendation. However, only 17% agreed that it was warranted for all newborns in their practice. Twenty-five percent expected more than one half of the parents to refuse three injections at a single well-child visit, a result of adding this vaccine to the current primary immunization schedule. Additionally, 42% expected nurses to resist giving three injections at one visit. Conclusions. The CDC does not have an effective mechanism for disseminating information to all physicians who care for children. Improved coordination of recommendations between the CDC and relevant specialty societies may help to increase physician adoption of new immunization recommendations in their clinical practice. Additionally, practical concerns of physicians and their patients regarding multiple injections and other practice-relevant issues must be considered when formulating new immunization recommendations, if their implementation is to be successful. Additional research is needed to determine effective methods to disseminate immunization information and to address practical concerns of clinicians., The incidence of hepatitis B infection has risen by 37% over the last decade and currently results in approximately 300,000 new infections annually.[1] This increase has occurred despite an immunization [...]

Objective. To examine response rate information from mailed physician questionnaires reported in published articles. Data Sources/Study Setting. Citations for articles published between 1985 and 1995 were obtained using a key [...]