How do we improve vaccination rates?

One way is to help parents get educated about vaccines, so that they understand that vaccines work, vaccines are safe, and that vaccines are necessary.

Strategies for Increasing Childhood Vaccination Rates

Vaccine-hesitant parents who might delay or skip some of their child’s vaccines aren’t the only reason vaccination rates aren’t where they should be though.

“Immunization levels in the United States are high, but gaps still exist, and providers can do much to maintain or increase immunization rates among patients in their practice.”

CDC on The Need for Strategies to Increase Immunization Levels

How do we fix these gaps in immunization rates?

Some easy things to do that can help increase vaccination rates might include:

• regularly posting vaccine education material on your social media accounts
• maintaining a good supply of vaccines
• reminding parents to bring their immunization records with them to each appointment, especially if they are new patients
• keeping accurate immunization records on each patient
• carefully recording vaccines that have been given outside your office
• using an immunization information system or immunization registry to make it easier to keep track of immunization records
• generating lists of patients who’s vaccines are past due
• using reminder and recall messages, either phone calls, text messages, or postcards, etc., so that parents are notified when vaccines are due soon or past due
• using an electronic health record system to automatically generate prompts when vaccines are due at well visits and sick visits
• manually reviewing your patient’s vaccination status at each visit, whether it is a sick visit, well visit, or just a nurse visit, to see if they need any immunizations. Remember, a mild illness is not usually a contraindication to getting vaccinated.
• reducing missed opportunities to vaccinate kids by using standing orders and “nurse only” or “shots only” visits for vaccinations
• having extended hours for some scheduled or walk-in vaccination clinics
• enrolling in the Vaccines for Children program to provide free vaccine to families who are uninsured

And most importantly, office staff need to get educated about vaccines too, especially about the anti-vaccine talking points that might keep some kids from getting vaccinated on time. They should also understand the immunization schedule and catch-up immunization schedule, so they can easily recognize which vaccines are due.

“Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine.”

Sturm et al, on Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings

Pediatricians who are getting frustrated talking to parents who have been refusing vaccines might also learn a few new things, including how to use presumptive language.

What is presumptive language?

In the HPV vaccination study quoted above, it was defined as “a matter-of-fact statement that the child was due for or would receive HPV vaccine that day or at a future date, conveying a positive stance toward vaccination.” This is in contrast to a nonpresumptive style that “involved questions or uncertainty,” such as “do you want to get a shot today?”

“High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them.”

Gilkey et al, on Provider communication and HPV vaccination: The impact of recommendation quality

In addition to using presumptive language, another study has found that “By endorsing HPV vaccine highly, recommending same-day vaccination, and emphasizing cancer prevention, providers may be able to promote HPV vaccine initiation and completion while discouraging vaccine refusal and delay.”

Can these strategies work for your office?

What to Know About Increasing Childhood Vaccination Rates

From using reminder systems and standing orders to changing how you talk to parents, there are a lot of things that can be done to increase childhood vaccination rates.

More on Increasing Childhood Vaccination Rates

• CDC – Immunization Strategies for Healthcare Practices and Providers
• Suggestions to Improve Your Immunization Services
• AAP Policy Statement on Increasing Immunization Coverage
• AAP – Quality Improvement Projects for Immunizations
• AAP – ​Office Strategies for Imp​​roving Immunization Rates
• AAP – Immunization Reminder and Recall Systems
• Study – Increasing adolescent immunization rates in primary care: strategies physicians use and would consider implementing.
• Study – Improving HPV Vaccination Rates Using Maintenance-of-Certification Requirements
• Study – Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings.
• Study – Provider communication and HPV vaccination: The impact of recommendation quality.
• Study – Text message reminders for second dose of influenza vaccine: a randomized controlled trial.
• Standing Orders for Administering Vaccines
• Executive Summary—Actions to Strengthen Adult and Adolescent Immunization Coverage in the United States: Policy Principles of the Infectious Diseases Society of America
• Top Strategies for Increasing Immunization Coverage Rates
• Strategies for Increasing Adult Vaccination Rates
• First STEPS Phase I Initiative: Improving Immunizations for Children
• Improving Childhood Vaccination Rates
• Vaccine Adherence Improved with Text Message Reminders