BACKGROUND:
Immunization practices and practice characteristics may be important determinants of disparities in delivery of immunization services.

OBJECTIVE:
To examine immunization services delivered to patients according to their race/ethnicity.

METHOD:
A sample of 97 providers who per week routinely immunize >9 children < 2 years of age was selected from the American Medical Association master list. Providers were asked to collect information about vaccines administered, time spent with parents, and questions/issues discussed at each provider-patient encounter during a randomly selected week (n=752 provider/patient encounters). Chi Square tests were conducted to detect statistical significance.

RESULT:
Discussions about contraindications (37%), whether vaccines work (37%), number of vaccines administered (42%), and the necessity of the vaccines (46%) occurred less than expected. Compared to non-Hispanic white and non-Hispanic black children, providers were more likely to talk to parents of Hispanic children about side effects, number of vaccines, safety and necessity of vaccines, whether vaccines work, and what to do if a child experienced pain (p=<0.01). Rates varied by practice size. Providers in small practices (<500 patients) spent more time (> 15 minutes) talking with patients about immunization than providers in larger (>1000) practices (p=0.01). Rates varied by patients' race/ethnicity.

CONCLUSION:
Topics discussed and time spent with patients during immunization encounters differed by child's race/ethnicity and practice size. Providers were more likely to discuss more immunization topics with parents of Hispanic children than children of other race groups; integrating both factors as standard immunization practice is recommended.

LEARNING OBJECTIVES:
To learn about differences in immunization practices and practice characteristics that may promote disparities in immunization.