Strategies for Increasing Adolescent Immunization Rates In Primary Care: What Physicians Use & Would Consider

Background: Although most adolescents attend a primary care practice, US adolescent immunization rates are low. 

Objectives: To understand whether strategies recommended by CDC to optimize immunization rates are currently used, or would be considered for use by practitioners. 

Methods: In spring 2010, we surveyed physicians from 2 primary care practice-based research networks (PBRNs): a western NY regional network (pediatrics, family physicians) and a national network of pediatric residency training continuity clinics (CORNET).  Depending on their preference, we sent a mailed or on-line survey about increasing adolescent immunization rates -- both (a) current use of interventions and (b) preferences for strategies offices would consider using. We sent up to 5 rounds of the survey (or reminders) and included a $5 gift card incentive.

Results: The response rate was 76% (148 of 195 practices [1 MD/practice]). Results from the 2 PBRNs were similar and so were combined. Practices served patients in urban (43%), suburban (36%), or rural (21%) locations. The most frequently named first choices of strategies are shown below in this order: (Currently used and effective), (Not currently used but would consider). (a) Prompts to healthcare provider via Electronic Medical Records—11%, 36%; (b) Prompts to healthcare provider via office staff—24%, 8%; (c) Patient reminder and/or recall (e.g., phone call, mail) —21%, 27%; (d) Having a list of patients in need of vaccination—1%, 9%.  Other evidence-based strategies (e.g., education for the patient or the healthcare provider, vaccine clinics, vaccine-only visits, audit and feedback, standing orders) were selected less frequently.

Conclusions: The most commonly used and desired strategies to increase adolescent immunization in the medical home were prompts to providers to vaccinate those present or reminders to families to come in for vaccination.  A reasonable proportion of practitioners would consider strategies to enhance adolescent immunization delivery.