KEYWORDS:
Private Health Care Providers, CASA, AFIX, Immunization Coverage Rates

BACKGROUND:
Geographically, Kern County is the third largest county in the State of California, covering 8,073 square miles. Kern County has a population of 661,645 with 71,458 (10.8%) children under 6 years of age. Kindergarten immunization assessments have reported coverage rates from 35% in 1995 to 65% in 2001. It is estimated that more than 75% of all immunizations are administered in private health care provider offices in Kern County.

OBJECTIVE(S):
To assess immunization practices in Private Medical Doctor offices.

METHOD(S):
Private immunization health care providers were approached to recruit participation in the assessment project. The methods included: recruitment at public presentations, personal telephone calls, and office visits. The project used lunches and public recognition as incentives for participating in the project.
CASA, AFIX, and Quality Assurance Reports were conducted at participating practices. The Vaccine for Children's Quality Assurance Assessment form was used to evaluate their adherence to the Standards for Pediatric Immunization Practices.

RESULT(S):
Seven office practices participated in the project. Over 60 contacts (telephone calls and office visits) were made with these seven providers. Eleven CASA assessments were performed in the seven practices. Two of the seven practices achieved coverage rates higher than 90%. Nine AFIX sessions were conducted and seven QARs were performed in these practices.

CONCLUSIONS(S):
Personal telephone calls and office visits were more successful in recruiting participation while public presentations were ineffective. Over 60 contacts with office staff and clinicians were necessary to gain trust, assurance of confidentiality, and to develop a team approach. The key components to raising rates among the participants in this study were in-office updates, a demonstration of immunization rates with data, and requiring each practice to commit to a specific improvement plan.

LEARNING OBJECTIVES:
Describe the process, methods, and challenges of gaining access to Private Health Care Providers Offices.