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Improving vaccine risk/benefit communication with an immunization education package: a pilot study
Terry C Davis1, Doren D Fredrickson, Claire Bocchini
1Louisiana State University Health Sciences Center-Shreveport, Department of Pediatrics, 71130, USA. tdavis1@lsuhsc.edu
Insights
An Immunization Education Package (IEP) improved pediatrician compliance with vaccine risk/benefit communication mandates. This intervention significantly increased Vaccine Information Statement (VIS) distribution and parent-physician discussions with minimal time impact.
Area of Science:
- Pediatric Healthcare
- Public Health Communication
- Vaccine Education
Background:
- The National Childhood Vaccine Injury Act (NCVIA) mandates physician distribution of Vaccine Information Statements (VIS) and discussion of vaccine risks/benefits.
- Physician time constraints and low VIS utilization pose challenges to effective vaccine risk/benefit communication.
- Parents desire direct communication from primary providers regarding vaccine risks and benefits.
Purpose of the Study:
- To assess the feasibility of an Immunization Education Package (IEP) intervention.
- To improve pediatrician compliance with NCVIA mandates.
- To enhance vaccine risk/benefit communication between physicians and parents.
Main Methods:
- A before-after trial was conducted in two multi-physician private pediatric practices.
- An Immunization Education Package (IEP) intervention was implemented, including staff training and patient educational materials.
- Research assistants observed and recorded immunization discussion content and duration during well-baby visits.
Main Results:
- VIS distribution increased significantly from 33% to 91% (P <.001).
- Physician and nurse initiation of verbal vaccine teaching increased significantly (P <.001).
- Parent initiation of vaccine-related questions increased significantly (P <.001), with improved discussion of key immunization topics.
Conclusions:
- The IEP intervention is a feasible method to enhance compliance with NCVIA requirements.
- The IEP facilitated substantial improvements in vaccine risk/benefit communication to parents.
- Effective vaccine communication can be achieved with only a minimal increase in physician time.
Introduction:
The National Childhood Vaccine Injury Act (NCVIA) requires that physicians distribute the appropriate Vaccine Information Statements (VIS) at each immunization visit and discuss the risks/benefits of every vaccine given. In a national study, 31% of pediatricians reported not using the VIS and 56% indicated that time was a barrier to vaccine risk/benefit communication. Parents, however, indicated they want their primary providers to personally tell them about risks/benefits.
Objective:
To test the feasibility of an Immunization Education Package (IEP) intervention to improve compliance with the federal mandate and to improve physician/parent vaccine risk/benefit communication.
Setting:
Two multi-physician private pediatric practices in Shreveport, La.
Design:
A before-after trial with comparison of 130 pre-intervention and 78 post-intervention visits. Research assistants recorded content and duration of immunization discussions during well-baby visits during which immunizations were scheduled. Clinic staffs were masked as to variables recorded.
Intervention:
The IEP was a multifaceted intervention, involving a practice-based in-service and distribution and discussion of ready-to-use materials including an exam room poster entitled "7 Questions Parents Need To Ask About Baby Shots."
Results:
Patients were 90% white and 96% privately insured. Pre and post results revealed a significant increase in VIS distribution (33% vs 91%, P <.001) and physician and nurse initiation of verbal teaching about the vaccine (65% vs 100%, 32% vs 72%, respectively; P <.001 for both), and parent initiation of questions (0% vs 32%, P <.001). A significant increase was found in the discussion of 6 of 8 major immunization IEP topics: contraindications, common side effects, treatment of common side effects, severe side effects, management of severe side effects, and schedule of the next vaccination. These vaccine communication improvements were made with a very small (20-s) increase in physician time. In post-intervention focus groups, provider staff endorsed the IEP method.
Conclusions:
This IEP was a feasible way to facilitate compliance with the NCVIA. A significant amount of additional information was provided to parents with only a slight increase in time.