DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.
However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, M.P.H., reported during a poster session at the annual meeting of the Pediatric Academic Societies. The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.
Christina S. Albertin
"Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care," the researchers wrote in their poster.
Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester, N.Y., analyzed Medical Expenditure Panel Survey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations). They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.
Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.
Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations. In addition, the percentage of well child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.
The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008. Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%. The subgroups with significant increases included adolescents aged 14-17 years, females, whites, privately insured, and those from families with the highest income level.
"The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits," Ms. Albertin said in an interview. "I’m surprised by the results given that there are Tdap vaccine requirements in many states."
She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine. "Now, projected through 2011 it looks like that’s going to more than double," she said. "As a result, I think that we will slowly see an increase in both immunization-only and preventive visits."
Ms. Albertin said that she had no relevant financial conflicts to disclose.