BALTIMORE — According to a new study led by researchers at Columbia University Medical Center and NewYork-Presbyterian Hospital, there are several factors that contribute to children missing immunization visits.
The findings will be reported in a platform presentation at 8:30 a.m. ET on Tuesday, May 5, 2009, at the Pediatric Academic Societies (PAS) annual meeting here.
"We know that approximately 20 percent of our nation's young children are under-immunized, and previous research has identified many sociodemographic factors, such as lacking insurance or a usual source of care, that may lead to under-immunization. What we wanted to look at were families who actually had a place to go — their child has a health care provider — but they missed one or more immunization appointments," said the lead investigator, Melissa Stockwell, M.D., M.P.H., assistant professor of clinical pediatrics and population family health at Columbia University's College of Physicians & Surgeons and Mailman School of Public Health, medical director of the NewYork-Presbyterian Hospital Immunization Registry (EzVAC) and a pediatrician at NewYork-Presbyterian Morgan Stanley Children's Hospital.
"What we have identified are small steps that health care providers can take to improve keeping immunization appointments — such as talking with parents about the importance of immunizations, having open lines of communication with them, and making it easier for parents to schedule/reschedule appointments. We believe that the first step is making providers aware that how their clinic or office is set up can affect compliance with appointments — such as how long it takes to make an appointment or how rescheduling requests are processed," added Dr. Stockwell.
Dr. Stockwell and her research team surveyed the parents of 705 children under the age of three about immunization experiences. The interviews (conducted in both English and Spanish) took place at community health centers, hospital-based clinics, private practices, and community-based organizations in the Washington Heights, Harlem, Bronx, Upper East Side, and Upper West Side areas of New York City.
Parents who had to reschedule an appointment were found to be nearly four times as likely to miss their child's immunization appointment; those who had problems scheduling an appointment were also more likely to miss an appointment. Doubting the importance of vaccines made a parent more than three times as likely to miss appointments. Parents who reported difficulty communicating with their child's healthcare provider were nearly three times as likely to miss their child's scheduled immunization appointment.
A significant association was found between missed visits and under-immunization. Children whose parents reported missing an immunization visit were 2.5 times more likely to have been under-immunized (confirmed by parent-held immunization records, medical record or immunization registry).
"To remedy this situation, educational campaigns about the importance of immunization could help counter misperceptions about the benefits of these important protections against these potentially life-threatening, communicable diseases," said Dr. Stockwell. "Another possible solution may be the availability of online tools to help parents track their child's immunizations and give parents personal information about what immunizations their child needs and when they are due."
Online Management Tool Designed to Facilitate Immunizations:
One example is an online immunization management tool that will be available to patients and their families through NewYork-Presbyterian Hospital's new personal health record portal, myNYP.org. (Introduced earlier this month, myNYP.org gives patients the ability to select and store personal medical information generated during their doctor and hospital visits at NewYork-Presbyterian.) Dr. David Vawdrey, from the Department of Biomedical Informatics at Columbia, Dr. Stockwell and colleagues at the Hospital worked with Microsoft to create the myNYP.org Immunization Management Tool, a personal immunization tracking and reminder program.
"This technology will give parents a powerful tool to ensure their child is current on their immunizations, making it easy to learn about the timing of various immunizations and their importance. In addition, using the myNYP.org Immunization Management Tool, they will also be able to print their child's immunization records — something that can be useful for fulfilling school requirements," says Dr. Stockwell.
Additional Detail about the Missed Immunization Visit Study:
Additional researchers involved in the missed immunization visit study were Sally E. Findley, Ph.D., professor of clinical population and family health and clinical sociomedical sciences, Columbia University Mailman School of Public Health; Matilde M. Irigoyen, M.D., chair, Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, Pa.; and Raquel Andres Martinez, Ph.D., associate research scientist, Department of Pediatrics, Columbia University College of Physicians and Surgeons.
The research study was funded by the National Center for Immunization and Respiratory Diseases of the Centers for Disease Control and Prevention.
NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,242 beds. The Hospital has nearly 2 million inpatient and outpatient visits in a year, including more than 230,000 visits to its emergency departments — more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, NewYork-Presbyterian Hospital/The Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit www.nyp.org.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the most comprehensive medical research enterprise in New York City and state and one of the largest in the United States. Columbia University Medical Center is affiliated with NewYork-Presbyterian Hospital, the nation's largest not-for-profit hospital provider. For more information, please visit www.cumc.columbia.edu.
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