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A clinic system to improve preschool vaccinations in a low socioeconomic status population
P G Harper1, D J Madlon-Kay, M G Luxenberg
1Department of Family and Community Medicine, St Paul-Ramsey Medical Center, Minn., USA.
Insights
Implementing a clinic-wide system to assess and vaccinate preschool children at every visit significantly improved immunization rates. This proactive approach enhanced vaccination coverage for young children, though national goals remain unmet.
Area of Science:
- Pediatric Health
- Public Health Initiatives
- Preventive Medicine
Background:
- Vaccination rates for preschool-age children are critical for preventing infectious diseases.
- Achieving optimal immunization coverage requires effective clinic-based strategies.
- Previous approaches may not adequately address the needs of all children, particularly those with infrequent clinic visits.
Purpose of the Study:
- To evaluate the effectiveness of a systematic clinic-based approach for assessing and vaccinating preschool-age children during routine visits.
- To determine if a comprehensive clinic system can improve vaccination rates in a low socioeconomic status population.
- To assess the impact of a multi-stage intervention on immunization status at 24 months and study completion.
Main Methods:
- A nonequivalent control group design was employed, comparing an intervention clinic with a community health center comparison clinic in urban St. Paul, MN.
- The intervention involved a clinic-wide system engaging all staff to identify and vaccinate children at all clinic encounters.
- Vaccination status was measured by the percentage of children up-to-date for primary vaccine series at 24 months and at study end, both pre- and post-intervention.
Main Results:
- The intervention clinic demonstrated a significant increase in children up-to-date for primary vaccination series at 24 months (42% to 56%, P=.02).
- Vaccination rates at the intervention clinic also improved significantly by study end (49% to 63%, P=.02).
- The comparison clinic showed no significant changes in vaccination rates during the study period.
Conclusions:
- A systematic clinic-based assessment and vaccination protocol can substantially improve immunization rates among preschool-age children.
- Despite improvements, vaccination coverage in the intervention group remained below national targets.
- Combined clinic, community, and national efforts are necessary to achieve adequate vaccination rates in underserved populations.
Objective:
To determine if a clinic system to assess and vaccinate preschool-age children at every clinic visit can improve vaccination rates.
Design:
A nonequivalent control group design contrasting an intervention clinic with a comparison clinic.
Setting:
Two urban St Paul, Minn, clinics. The intervention clinic is a family practice residency clinic, and the comparison, clinic is a community health center clinic.
Patients:
Primarily a low socioeconomic status white population.
Interventions:
A clinic-wide system to identify and vaccinate children at all clinic visits. Appointment personnel, medical assistants, and physicians all had roles in the intervention protocol.
Main Outcome Measures:
Percentage of children at the 2 clinics who were up-to-date for a primary vaccine series at age 24 months and also at the end of the study collection periods, preintervention and postintervention.
Results:
The intervention clinic improved the percentage of children up-to-date for a primary vaccine series at age 24 months from 42% to 56% (P = .02), while the percentage at the comparison clinic did not change significantly (P = .81). Similarly, the intervention clinic improved the percentage of children up-to-date for age at the end of the study periods from 49% preintervention to 63% postintervention (P = .02), while the percentage at the comparison clinic did not improve significantly (P = .45). The system was especially useful for children with few visits to the intervention clinic.
Conclusions:
Although the intervention clinic resulted in a substantial improvement in vaccination rates for preschool-age children, rates remained well below national goals. A combination of clinic, community, and national initiatives may be needed to ensure appropriate vaccination rates for this challenging patient population.
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