Last year, approximately 33% of two year old members of Partnership Healthplan were not fully immunized. The majority of the parents of these children are not opposed philosophically to vaccination, but missed one or more vaccines because they did not have a visit scheduled for the vaccination to be given on time. Primary care offices with robust reminder and outreach systems achieve vaccination rates of over 80%, which is the 90th percentile of Medicaid nationwide, for this measure.
Approximately 5-10% of parents in our region are more vigorously opposed to vaccinating their children. Clinician conversation with parents can sway those who are ambivalent, but may be less successful for parents with extremely strong opposition to vaccination.
The American Academy of Pediatrics recommends asking parents who are refusing to vaccinate their children to sign a “Refusal to Vaccinate” form. The form, with an article discussing the use of the form, can be found on the APP website:
https://www.aap.org/en-us/Documents/immunization_refusaltovaccinate.pdf
At the August PHC Physician Advisory Committee meeting, the physician members discussed the use of this form. Several members indicated that their health centers/practices used the AAP refusal to vaccinate form. Here are a few interesting variations:
One provider indicated that if a parent signed the form, they would be removed from the automated reminder systems to vaccinate their child, although this did not preclude the clinician from bringing up the topic in person at the next well-child visit.
Another provider noted that well child visits decrease if vaccine-refusing parents decide to avoid brining children in because they do not like feeling pestered about vaccinating their children. Communicare Health Centers developed some language they use in a letter to outreach to such parents, to encourage well child visits, even for children whose parents do not want to vaccinate them. They agreed to share the language they used with us. Here it is:
To the parents of : ( Enter Patients Name)
Well-child care is more than vaccines. To vaccinate or not to vaccinate is a parent’s choice. While we, as your healthcare provider, strongly recommend vaccination, well-child exams are still important to make sure your child is growing and developing appropriately. If problems occur with growth or development and are found early, they can be dealt with and the child will do better. If they are found late, lifelong problems can result. We encourage you to continue to have your child seen for well-child care. Please call for an appointment.
We urge all our primary care provider organizations to discuss how they handle conversations with parents who are ambivalent and opposed to vaccination, using careful language to balance the need to vigorously encourage parents to allow their children to be vaccinated with a need to ensure the children stop receiving well-child visits altogether.
Submitted by: Robert Moore, MD MPH MBA, Chief Medical Officer