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Fragmented Vax System Shifts PCP Role for Childhood Immunizations

Primary care physicians are missing key opportunities to discuss with parents the gamut of vaccinations their children should receive, a new survey has found.

The COVID-19 pandemic has upended the usual delivery system for childhood vaccines, traditionally the province of pediatricians and other primary care providers, according to researchers at the University of Michigan, Ann Arbor. Some parents are not turning to these clinicians for vaccine advice, looking instead to pharmacists or other providers with questions, according to the survey, which points to a possible shift in the role of primary care providers when it comes to vaccine advice.

“The usual paradigm is that the child’s primary care provider is the ‘go-to source’ for parents to discuss any questions they have about vaccines,” said Sarah Clark, MPH, the director of the CS Mott Children’s Hospital’s  National Poll On Children’s Health . “In this report, data show that parents continue to follow that usual paradigm for vaccines needed for school. However, we saw a very different pattern for COVID vaccine and, to a lesser extent, flu vaccine. These findings suggest a shift in parents’ reliance on primary care providers to discuss their child’s vaccines.”  

Clark and her colleagues surveyed 1483 parents of children ages 6-18 years about their discussions with health providers related to vaccines.

Most parents (82%) discussed school-related immunizations with their child’s doctor. Only 57% of parents discussed options for the COVID-19 vaccine, and 63% asked about flu vaccines, the survey found.

Some parents reported talking with other health professionals, such as pharmacists or nurses, about flu (8%) and COVID vaccines (14%). 

But 15% of parents said they did not discuss any vaccines with their child’s doctor and 3% of parents said they avoided healthcare visits for their child to prevent conversations about vaccines. 

A quarter of parents surveyed said they had trouble accessing vaccines for their children, issues such as having to find another provider or travel to another location to receive the shots.

These difficulties may reflect a temporary disruption to the typical process for pediatric vaccinations, according to Clark.

“Normally, we have the conversation, and then the parent makes the decision that the vaccine is administered right then and there,” Clark said. “With the COVID vaccine and to a little lesser extent, the flu vaccine, we’ve torn the process apart in many situations, simply because the vaccine isn’t located on site.”

Parents who talked with their doctors largely reported being satisfied with the outcomes of these discussions that informed their decision about vaccines. They also were more likely to report that their child had been vaccinated. Nearly 90% of parents overall reported that their child received vaccines required for school, while 57% said their child received vaccines against flu or COVID.

Around 6% of parents reported that their child had not received any vaccine, according to the poll. Of those, 43% reported having no discussions about vaccines with any healthcare provider in the past 2 years.

Lack of information about vaccines contributes to the hesitancy of some parents in scheduling vaccine and well-child appointments, Clark said.

“Most parents don’t have the scientific background, time and access to information to figure out things on their own,” Clark told Medscape Medical News. “Having someone to have the conversation with who knows the science and knows the family is invaluable.”

Clark urged parents not to skip out on a whole well-child visit because the conversation about vaccines could be uncomfortable. “There are other parts of a child’s health they are missing out on by not going to those appointments,” she said. 

She also encouraged parents to ask questions of their doctors and urged providers to expect those questions.  

“The regular provider should be a go-to resource for parents,” Clark said. “It’s okay to have questions and get those questions answered.”

Meanwhile, a report from the Centers for Disease Control and Prevention released earlier this month found that:

  • 59% of unvaccinated children aged 6 months to 4 years had parents who were open to vaccinating their children

  • 37% of unvaccinated children had parents reluctant to vaccinate their children

  • Hispanic, Black, and Asian parents were more open to vaccination than White parents

Kristina K. Bryant, MD, an expert in pediatric infectious diseases and professor at the University of Louisville School of Medicine in Kentucky, said that the burden is on clinicians to turn office visits into opportunities to improve vaccination rates.

“Healthcare visits in every setting are an opportunity to discuss the benefits of vaccination, and it is our job to initiate the conversation,” she said. “Eliminating the barriers to access described by these parents can increase vaccination rates, especially for flu and COVID-19 vaccines.”

CS Mott Children’s Hospital. National Poll on Children’s Health: Mott Poll Report. Published online November 21, 2022. Full text

The study was funded by CS Mott Children’s Hospital. Clark and Bryant report no relevant financial relationships. 

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