Immunization Delivery In Teen Clinics - Views of Teen Clinic Medical Directors

Background: Teen clinics primarily serve youth living in underserved urban centers and rural areas who have few other sources of confidential medical care and often have limited access to preventive care services such as immunizations. Little is presently known about factors affecting immunization delivery in teen clinics.

Objectives: To assess factors affecting immunization delivery in teen clinics.

Methods: A 25-item survey about immunization practices was sent to the medical directors of all 305 teen clinics in the U.S. Results were analyzed using descriptive statistics and statistical tests were used to compare proportions, means and medians.

Results: 165 teen clinic medical directors (54%) completed the survey. 92% of teen clinics offer some immunizations to adolescents while 80% offer adolescents all recommended immunizations. HPV vaccine and hepatitis B vaccine were rated as the most important adolescent vaccines. While most teen clinics require parental consent to administer vaccines, significantly fewer teen clinics do so for administration of hepatitis B vaccine (72%) and HPV vaccine (74%) than for administration of any other vaccine (> 88%; P<.001). Teen clinic medical directors whose clinics do not require parental consent for hepatitis B vaccine and HPV vaccine rated the importance of those vaccines significantly more hightly than did other teen clinic medical directors (2.95 and 2.94 vs. 2.62, P=.02). The most commonly cited barriers to providing vaccinations to adolescents under age 18 in teen clinics were difficulty making contact with parents to obtain consent and limited access to adolescents' immunization records (both cited by 52% of respondents).

Conclusions: While most teen clinics surveyed offer adolescent immunizations, the perceived importance of particular vaccines was associated with policies for consent and immunization. Expansion of immunization information systems (registries) should improve access to adolescents' immunization records, which would help address a common barrier to adolescent immunization delivery in this setting.