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Effect of emergency department immunization on compliance with primary care
1Section of Emergency Medicine, St. Christopher's Hospital for Children, Philadelphia.
Insights
Emergency Department (ED) immunizations do not significantly impact children's future primary care compliance. Parental reports of immunization status are unreliable, and an immunization database could prevent unnecessary vaccinations.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Immunization is crucial for child health maintenance.
- Emergency Departments (EDs) are increasingly involved in acute care, presenting opportunities for interventions.
- The impact of ED-based immunizations on long-term primary care adherence is not well understood.
Purpose of the Study:
- To evaluate if immunizing children in the Emergency Department (ED) influences their subsequent compliance with primary care recommendations.
- To assess the reliability of parental reporting of immunization status in the ED setting.
Main Methods:
- A cohort study comparing children immunized in an urban, tertiary care pediatric hospital's ED with matched controls.
- Data collection included parental reports and clinic records for immunization status and health maintenance visit attendance.
- Follow-up occurred over six months post-ED visit.
Main Results:
- No significant differences were found in primary care visit attendance or immunization status between ED-immunized children and controls at six months.
- Parents inaccurately reported their child's immunization status in 23% of cases.
- 18% of children received measles immunization in the ED despite prior immunization, and 28% received unnecessary subsequent immunizations.
Conclusions:
- Immunization within an Emergency Department (ED) setting does not substantially affect children's long-term adherence to primary care schedules.
- Parental recall of immunization history is unreliable in the ED.
- Implementing an immunization registry or database is recommended to minimize redundant and inappropriate vaccinations.
Abstract:
The purpose of this study was to determine whether immunization of children during treatment in an Emergency Department (ED) affects subsequent compliance with primary care. This cohort study of children immunized in the ED and matched controls was conducted in the ED and the pediatric clinic in an urban, tertiary care, pediatric hospital. Forty children were enrolled in study and control groups. There were no differences in age, race, sex, insurance status, temperature on arrival, and discharge diagnoses between groups. The immunization status by parental report and as documented in the clinic records was similar for immunized and control patients. There was no difference in attendance at health maintenance visits during the six months after the ED visit between immunized and control patients. No differences in receipt of immunizations or in immunization status were noted after six months. The sample size has adequate power to conclude that the difference in subsequent compliance with primary care between immunized and control patients is less than 50%. Parents reported their child's immunization status incorrectly in 23% of cases. Patients receiving measles immunization in the ED had already been immunized in 18% of cases. Unnecessary subsequent immunization of study patients occurred in 28% of cases. In conclusion, immunization in an ED does not have a large effect on subsequent compliance with primary care. In the ED, parents are an unreliable source of information about immunization status. An immunization database could reduce the frequency of inappropriate immunization.