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Rural Survey Hopes to Answer Immunization Questions

   Portland, Ore.

Whooping cough outbreak in Douglas County highlights need to know more about childhood immunizations

A recent outbreak of 50 pertussis cases, or whooping cough, in Oregon's Douglas County this winter highlights the need to understand how children's immunizations are being coordinated and tracked in rural Oregon. Oregon Health & Science University researchers hope to find out why some children still are not fully immunized.

The OHSU Oregon Rural Practice-based Research Network (ORPRN) and the Oregon Department of Human Services have launched a statewide study of childhood immunizations, called the Rural Oregon Immunization Initiative. The study will look at several important questions regarding rural clinicians' approaches to immunization services, methods for tracking immunizations and barriers to timely immunizations for children.

"Through the survey we want to understand how children are getting their immunizations around the state. We want to find out who is getting immunizations, where they are getting them, and what are the attitudes and practices of clinicians in rural communities. Plus, we currently don't have a system in place to immunize a community quickly when we do have an outbreak, such as the whooping cough occurrence in Douglas County," said L.J. Fagnan, M.D. director of ORPRN and associate professor of family medicine, OHSU School of Medicine.

"Most providers are trying to do a good job with immunizing children. But with even more immunizations to give, assuring that their patients get immunized appropriately has become more difficult for already busy providers. The State Immunization Program is committed to helping providers improve their practices. However, we don't know how best to work with Oregon rural practices to do that. We do know we need to hear what's going on from the rural practitioner's point of view. This survey will help us do that," said James Gaudino, M.D., M.S., M.P.H., co-investigator and senior immunization medical epidemiologist with the Oregon Department of Human Service's Office of Family Health.

In Reedsport, Douglas County, where the recent whooping cough outbreak occurred, physicians witnessed the strengths and weaknesses of the Oregon Immunization ALERT program, a statewide childhood immunization registry, firsthand.

"It will be helpful to see how others throughout the state are tracking immunizations. We want to find ways to be more effective. After we see the results of the survey, we will solicit ideas about making the immunization program more effective," said Janet E. Patin, M.D., family practice at Dunes Family Health Care in Reedsport.

The first phase of the project consists of a survey of all 1,200 Oregon rural clinicians to provide a picture of current immunization practices and barriers. The survey was mailed in mid-December. Clinicians have been asked to respond quickly to provide timely feedback. A second mailing is planned for mid-January. Results of the survey are expected in early spring. They will be used to develop subsequent phases of the study, which will focus on better understanding and addressing gaps that exist in childhood immunization coordination, tracking and delivery.

The Oregon Rural Practice-based Research Network was established in 2002 with the mission of improving the health of rural populations in Oregon through conducting and promoting health research in partnerships with Oregon's communities and their medical practitioners. The Network works with 28 physicians' offices located in 23 rural Oregon communities. The practices include 120 primary care clinicians who care for more than 150,000 patients. The network has researchers and research coordinators located throughout the state of Oregon.

The OHSU Oregon Rural Practice-based Research currently works with these communities: Wheeler; Pacific City; Lincoln City; Siletz; Yachats; Reedsport; North Bend/Coos Bay; Klamath Falls; Lakeview; Scappoose; Hood River; The Dalles; Condon; Redmond; Hermiston; Elgin; Union; Enterprise; Halfway; Baker City; John Day; Burns and Ontario.

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