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Personalized approach may be key to addressing vaccine-hesitancy

NEW YORK — An individualized approach may be best when addressing concerns of vaccine-hesitant parents, according to a presenter at the 2014 Infectious Diseases in Children Symposium.

Although strategies such as standing orders and reminder/recall messaging systems have been shown to improve vaccination rates among children, many physicians may not utilize these strategies because they may seem difficult to implement or are potentially costly, according to Sean O’Leary, MD, MPH, from the department of pediatrics at the University of Colorado.

Sean O'Leary

“Standing orders are the most effective evidence-based method for increasing vaccine uptake,” O’Leary said. “And perhaps more importantly, they have the potential to streamline the vaccination encounter and give physicians time to focus on other important topics. Implementing a standing order system may be particularly useful for the adolescent vaccinations where we know rates are low.”

Many practices do not use reminder/recall messaging systems because they can be expensive and time-consuming, according to O’Leary. However, having state or local health departments collaborate with practices to conduct reminder/recalls is a solution that is currently being explored.

“Using a centralized reminder/recall system lessens the burden on providers and has the potential to reach children without a medical home,” O’Leary said. “Further, a recent study showed using a centralized reminder system was both more effective and less expensive than having practices do it themselves.”

Despite these beneficial existing strategies, adolescent vaccine uptake is less than ideal in the United States. Vaccine-hesitant parents are a significant contributor to this.

“A recent survey of pediatricians found 46% reported their job was less satisfying because of the need to discuss vaccines with vaccine-hesitant parents and 60% of pediatricians reportedly spend more than 10 minutes of a visit discussing vaccines with vaccine-hesitant parents,” according to O’Leary.

The CDC and the AAP have developed strategies for talking with vaccine-hesitant parents, based on extensive focus groups and interviews with parents and providers. However, these strategies have not been tested in randomized trials, and therefore cannot be considered evidence-based.

“Anecdotally, physicians report these techniques are effective, but they have not really been rigorously tested and therefore cannot be considered evidence-based,” O’Leary said. “We need evidence-based techniques for addressing the growing problem of vaccine hesitancy.”

Tailored messaging and social media are two strategies currently being tested for effectiveness among vaccine-hesitant parents, according to O’Leary.

Tailored messaging involves personalizing messages using a patient’s name and race, receiving feedback and then matching content to what the most important issues are to that specific patient and patient family.

A current randomized study conducted within Kaiser Permanente in Colorado is evaluating effectiveness of a social media website vs. a regular website plus usual care.

“Essentially the study researchers are trying to create a trustworthy site where parents with questions can go for good information,” O’Leary said. “The website was developed based on parent input and features moderated chat rooms and question/answer sessions with vaccine experts.”

While these strategies are being tested, physicians may improve adolescent vaccine uptake by having presumptive discussions with parents vs. participatory discussions. Physicians should use a more definitive statement, such as “It’s time for some shots,” vs. “Have you thought about which shots you’d like to get today?”

“By taking a presumptive tone parents are made to feel that having their child vaccinated is the normal thing to do,” O’Leary said. “Therefore they may not only be less likely to resist but may be more comfortable with that decision.”

For more information:

O’Leary S. “Improving vaccine uptake.” Presented at: IDC NY 2014; November 22-23, 2014; New York.

Disclosure: O’Leary reports no relevant financial disclosures.