A clinic system to improve preschool vaccinations in a low socioeconomic status population
P. G. Harper, D. J. Madlon-Kay, M. G. Luxenberg and R. Tempest
Department of Family and Community Medicine, St Paul-Ramsey Medical Center, Minn., USA.
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.
