Improving quality by encouraging providers to use pediatric combination vaccines

In the last 4 decades, the number of diseases that vaccines can prevent has quadrupled, and, correspondingly, so has the number of immunizations that is to be administered before a child's second birthday. Based on current recommendations, a child may receive as many as six vaccine injections in a single visit. Vaccine technology has advanced significantly since the introduction of the first combination vaccine, diphtheria-tetanus (DT), in the 1950s. In the United States today, as many as five antigens can be administered in a single injection, and additional combination vaccines are in the pipeline. Increasing the number of antigens delivered with a single injection minimizes physical discomfort for the child, reduces associated stress for the parent, saves time for the provider, and is likely to improve vaccine coverage and timeliness of administration rates. While national immunization guidelines from the Centers for Disease Control and Prevention call for use of combination vaccines where available, provider and parent perceptions can act as barriers to their optimal use. Managed care organizations (MCOs) have the opportunity to improve quality of care and immunization rates by educating providers on the use of combination vaccines in accordance with the national guidelines. This article examines the evidence for pediatric combination vaccines, discusses barriers to their use among parents and providers, presents quality and cost implications of a managed care policy to broaden their use, and suggests ways in which MCOs can more actively promote appropriate use of combination vaccines by providers.