Physicians' Strategies for Adolescent Vaccination In Conjunction with Other Clinical Preventive Services

Background: Coverage rates for teens continue to fall below Healthy People 2010 goals despite nation-wide educational initiatives emphasizing their importance. The purpose of this study is to look at how vaccines compete with or enhance other adolescent clinical preventive services (CPS) and how physicians prioritize competing activities including vaccination, counseling, and physical exams.

Setting: Private practices and community health clinics representing a cross-section of pediatric, teen, and family medicine providers in San Diego County, California.

Population: A convenience sample of twelve medical directors and lead physicians.

Project Description: Key informant interviews were conducted with the medical director or lead physician of each participating clinic. Participants were asked questions about how they implement vaccine policies along with other CPS during sick and well visits with adolescents aged 11 to 17 years old.

Results/Lessons Learned: Participants reported Pay for Performance, HEDIS, and vaccine reimbursement as “not influential” for adolescent vaccine or CPS counseling delivery. No clinic used Reminder/Recall systems for vaccines other than HPV with a vaccine manufacturer’s reminder system being most frequently employed. Reminder/Recall was rarely used for adolescent well-visits. The majority of participants reported the desire to implement a phone or email reminder system if their clinic had more resources. Participants identified parents’ attitudes toward vaccines, teens’ fear of needles, lack of vaccination history for new patients, and the infrequency of adolescent visits as barriers to adolescent vaccination. Lack of time during appointments was most frequently reported as a barrier to CPS counseling. Participants generally supported alternative vaccination sites for teens as long as the site could appropriately document vaccination. Physical exams and CPS counseling ranked higher in importance than vaccination when discussing time management at appointments. Participants reported reviewing immunization records during sick visits but not always administering vaccines at those visits, thus missing opportunities for vaccination.