25112 Fitting It All In: Do Immunizations Interfere with Other Preventive Services for Adolescents?

Tuesday, March 29, 2011: 11:40 AM

Background:  Primary care providers must balance delivery of immunizations with other services offered at adolescent preventive care visits.

Objectives:  Assess rates of counseling for recommended preventive care topics (18 for younger, 21 for older teens), including risky behavior, sexual activity and STIs, weight, healthy diet and exercise, emotional health and relationship issues for adolescent patients who did and did not receive vaccines at well visits.

Methods:  We recruited 208 young adolescents (aged 11-13), and 240 older adolescents (aged 14-17) from 11 primary care practices in upstate NY.  Participants were eligible if they were at the office for a preventive care visit or had recently had one. After obtaining consent/assent, teens were surveyed by e-mail or phone using the Young Adult Health Care Survey to assess the extent of counseling that occurred at their visits. Immunizations documented by providers were measured by chart reviews. Negative binomial regression was used to measure differences in the percent of counseling topics covered, controlling for whether or not a vaccine was given, patient gender, provider type (peds, family med), and patient age.

Results:  Fifty percent of 11-13 year olds and 25% of 14-17 year olds received at least one vaccine at their preventive care visit. Overall, the median proportion of topics discussed was 0.39 and 0.42, for young and older adolescents, respectively. In regression analysis, patients reported receiving more counseling if they did not get a vaccine, were female, saw a pediatrician, and were older (19%, 22%, 27%, and 4% [per year of age] more counseling received, respectively, p≤0.01 for all).

Conclusions: Receiving vaccinations has the potential to detract from other counseling topics covered at preventive visits. Since visit time is limited, strategies are needed to assist providers in incorporating adolescent vaccinations into preventive visits without reducing discussions of other preventive care topics.