A new study led by Allison Kempe, MD, MPH, professor of Pediatrics at the University of Colorado School of Medicine and director of the Children's Outcomes Research (COR) Program at The Children's Hospital, reports the results of a national survey of primary care physicians who deliver vaccinations to children. Major findings include a majority of physicians think that parents' level of concern about vaccines has either greatly or moderately increased in the past five years and that they are spending a significant amount of time at well child visits discussing vaccine safety with parents. Relying only on discussion of vaccines at visits where vaccines are needed may be too time-consuming and inadequate and may compromise providers' ability to focus on other important health care topics.
The study publishes in the May issue of American Journal of Preventive Medicine and online April 15.
According to the study results, in a typical month, 79 percent of physicians report at least one vaccine refusal; 8 percent report refusals for more than 10 percent of children. And, 89 percent report at least one request to spread out vaccines -- 20 percent report these requests for more than 10 percent of children.
Other study findings include the following:
40 percent of physicians always or often require parents to sign a form if they refuse a vaccination. Most physicians would agree to spread out vaccines in the primary series at least sometimes. Approximately 10 percent of physicians would often or always dismiss families from their practice if they refuse vaccines in the primary series and another 5 percent would sometimes do so. Although few physicians had considered no longer providing vaccines because of the need to discuss vaccine risks and benefits, about one-third of physicians reported that these discussions were negatively impacting their job satisfaction. From the physicians' perspective the most successful messages in convincing skeptical parents were personal ones, such as the fact that they vaccinated their own children or grandchildren, discussions of their personal experiences with vaccine safety or with vaccine-preventable diseases, or a statement that they think it is safer to vaccinate than not to vaccinate."
Primary care providers in this country have been doing a terrific job trying to counter the misinformation about vaccine safety that is so abundant on the internet and other media, but they are spending a great deal of their time at well visits discussing these issues alone," said Kempe. "The amount of time physicians have in a well child care visit to cover a lot of health care topics is very limited and they are not being paid for the lengthy discussions some parents with concerns need to have. Most importantly, they may have to compromise other health care topics if these discussions are long. Clearly, primary care physicians would benefit from a multi-pronged approach, with greater use of educational methods before visits or different educational forums such as group visits and much more effective use of media and social marketing to counter misinformation."
Kempe believes the multi-pronged approach should include the following:
- Increased use of social marketing aimed at vaccine hesitant parents.
- Efforts to directly counter misinformation about vaccines in the media, on talk shows and on the internet -- actively involving parents in this effort may be key in engaging those who are suspicious of "experts" or governmental agencies.
- Increased use of more efficient educational methods at the practice such as prenatal visit consultations, group parent meetings, internet site recommendations or mailed materials for parental education prior to well visits.
- More physician training in effective discussions of risk and benefits of vaccines.
- Physicians need to be able to bill for time spent discussing parental concerns that are outside of the time usually allotted for well visits.
- Physicians may be most effective if they use personal messages in their discussions of the risks and benefits of vaccines such as their own decisions to vaccinate their children.
Kempe is also the 2011 winner of the Academic Pediatric Association Research award. The award recognizes the highest level of research excellence and achievement in the field of general pediatrics. Kempe's research has led to improved child health policies in health disparities among underserved populations, state Children's Health Insurance Programs funding, and immunization delivery, policies and practices. She will receive her award during the Pediatric Academic Societies' 2011 Annual Meeting in Denver on May 1.
- Allison Kempe, Matthew F. Daley, Mary M. McCauley, Lori A. Crane, Christina A. Suh, Allison M. Kennedy, Michelle M. Basket, Shannon K. Stokley, Fran Dong, Christine I. Babbel, Laura A. Seewald, L. Miriam Dickinson. Prevalence of Parental Concerns About Childhood Vaccines: The Experience of Primary Care Physicians. American Journal of Preventive Medicine, 2011; 40 (5): 548 DOI: 10.1016/j.amepre.2010.12.025
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