Fitting It All in: Incorporating New Adolescent Vaccines into Preventive Care Visits for Adolescents

Background:
It is unknown how physicians are prioritizing new adolescent vaccine recommendations with other clinical preventive services recommended for delivery during a well child visit (WCV).

Objectives:
Assess the perceptions of physicians about the effect of providing new immunizations for adolescents on their delivery of other preventive services.

Methods:
Semi-structured phone interviews of primary care providers in upstate New York were performed. A wide variety of practice types were recruited with purposeful sampling to include private suburban, community health center, urban and rural practices and both family physicians and pediatricians.

Results:
19 primary care providers from 6 pediatric and 4 family practice groups were interviewed. Most providers addressed vaccines for adolescents at WCV, and generally gave the initial HPV vaccine at a WCV. Providers reported that discussion about vaccines added from 3-10 minutes to their preventive visits, yet visits were not scheduled for a longer time than they had been previously. Most preferred to leave this discussion to the end of the visit unless the parent brought it up sooner, since discussing vaccines earlier made adolescents anxious. The majority reported discussing the same preventive topics they had in the past, although several commented that when busy, they may omit discussing topics that adolescents do not check off on a practice-specific behavior assessment form. Providers reported that a common effect of the vaccine discussion was that it ‘puts me farther behind'. Practical solutions offered by the providers included using a risk assessment form to focus on the adolescent's major concerns, giving information handouts on vaccines, and scheduling follow-up visits to further address some patient concerns.

Conclusions:
Discussion of new adolescent vaccines adds to the strain of preventive services offered by primary care physicians. The solutions suggested above have helped some to incorporate the vaccines into their practice of well adolescent care.