Adolescent Immunization in Emergency Departments - Views of Parents and Emergency Physicians

Background:  In the past few years, several vaccines have been recommended for adolescents. Since adolescents are typically not high utilizers of primary care services, many adolescents so not receive recommended immunizations. Emergency departments (EDs) are often a source of medical care for adolescents who do not get medical care in primary care settings.

Objectives: To assess the opinions of parents of adolescents and of ED physicians regarding the provision of adolescent immunizations in EDs.

Methods: An on-line survey of a large stratified random sample of parents of U.S. adolescents ages 11-17 concerning adolescent immunization was conducted by the Harris Poll On-Line during a 1-week period in January 2009 until 557 parents completed the survey, thereby providing a 95% probability that the overall results would have a sampling error of no more than +/- 4%. A separate national survey of emergency physicians concerning adolescent vaccination in EDs was conducted on-line and by mail between September 2008 and May 2009; 51% (264/519) of sampled ED physicians responded with 246 fully completing the survey. Descriptive statistics were used to describe the survey results.

Results: When parents of adolescents were asked their opinions about having needed vaccinations offered to teens in EDs when teens present there, 54% favored or strongly favored it, 15% opposed or strongly opposed it and 31% neither favored nor opposed it. 90% of ED physician respondents indicated that their EDs currently provide Tdap vaccine, while 20% indicated that their EDs provide influenza vaccine; few ED physicians reported that other vaccines are offered to adolescents in the ED. Half of responding ED physicians considered the provision of influenza vaccine in the ED to be somewhat or very important while 33%-45% believed that it is important for EDs to offer each of the other recommended adolescent vaccines. The main potential barriers to providing vaccinations to adolescents in the ED were the perceived incompatibility with the ED's emphasis on providing acute care, lack of access to adolescents' immunization records, and time constraints for ED nurses.

Conclusions: While most parents favor having EDs offer needed vaccinations to adolescents and many ED physicians think it is important to offer various vaccinations to adolescents who present there, a number of modifiable barriers exist that may limit ED immunization efforts.