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German PH, Lazenby M, Phillips S, Jun A. The Effect of a Quality Improvement Project on Improving Patients' Willingness to Receive an Influenza Vaccination in the Emergency Department. J Immigr Minor Health 2024; 26:474-481. [PMID: 38172454 PMCID: PMC11096210 DOI: 10.1007/s10903-023-01574-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
The aim of this project was to increase willingness to receive the influenza vaccine to the optimal rate of ≥ 70%. Low acuity adult patients who visited an Emergency Department (ED) were assessed regarding their willingness to receive the influenza vaccine before and after an educational intervention that included a provider recommendation and an educational handout. A total of seventy-six patients (n = 76) were assessed. Patients' willingness to receive the influenza vaccine rose from 29% pre-intervention to 72% post-intervention without disrupting the clinical flow in a busy ED. Similar vaccine educational strategies can be applied to influenza and other vaccines in EDs to increase vaccination willingness in patients, including those who use the ED as a primary point of contact for healthcare, decreasing the burden of influenza illness in the community.
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Affiliation(s)
- Paola H German
- Sue and Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Road, Irvine, CA, 92697, USA.
| | - Mark Lazenby
- Sue and Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Road, Irvine, CA, 92697, USA
| | - Susanne Phillips
- Sue and Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Road, Irvine, CA, 92697, USA
| | - Angela Jun
- Sue and Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Road, Irvine, CA, 92697, USA
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Rodriguez RM, Eucker SA, Rafique Z, Nichol G, Molina MF, Kean E, O'Laughlin KN, Bezek SK, Goicochea K, Ford JS, Morse D, White J, Arreguin MI, Shughart L, Chavez CL, Glidden DV, Rising KL. Promotion of Influenza Vaccination in the Emergency Department. NEJM EVIDENCE 2024; 3:EVIDoa2300197. [PMID: 38776635 DOI: 10.1056/evidoa2300197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Influenza vaccine uptake is low among underserved populations whose primary health care access occurs in emergency departments. We sought to determine whether implementation of two interventions would increase 30-day influenza vaccine uptake in unvaccinated patients in the emergency department. METHODS This three-group, prospective, cluster-randomized controlled trial compared two interventions with a control group in noncritically ill, adult patients in the emergency department who were not vaccinated for influenza in the current vaccine season. The unit of randomization was individual calendar days. Participants received either Intervention M (an influenza vaccine messaging platform consisting of a video, one-page flyer, and scripted message, followed by a vaccine acceptance question and provider notification if participants indicated vaccine acceptance), Intervention Q (no messaging but the vaccine acceptance question and provider notification), or control (usual care/no intervention). The primary outcome was receipt of an influenza vaccine at 30 days ascertained by electronic health record review and telephone follow-up, comparing the Intervention M group with the control group. Secondary outcomes included comparisons of 30-day vaccine uptake in Intervention Q versus control and Intervention M versus Intervention Q. RESULTS Between October 2022 and February 2023, a total of 767 trial participants were enrolled at six emergency departments in five U.S. cities. Median age was 46 years; 353 (46%) participants were female, 274 (36%) were African American, and 158 (21%) were Latinx; 126 (16%) lacked health insurance, and 244 (32%) lacked primary care. The Intervention M, Intervention Q, and control groups had 30-day vaccine uptakes of 41%, 32%, and 15%, respectively (P<0.0001 for Intervention M vs. control). Comparing Intervention M versus Intervention Q, the adjusted difference in 30-day vaccine uptake was 8.7 percentage points (95% confidence interval, -0.1 to 17.6 percentage points). CONCLUSIONS Implementation of influenza vaccine messaging platforms (video clips, printed materials, and verbal scripts) improved 30-day vaccine uptake among unvaccinated patients in the emergency department. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT05836818.).
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Affiliation(s)
- Robert M Rodriguez
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | | | - Zubaid Rafique
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, Seattle
| | - Melanie F Molina
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Efrat Kean
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia
| | | | - Sarah K Bezek
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston
| | | | - James S Ford
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Dana Morse
- Department of Emergency Medicine, University of Washington, Seattle
| | - Jaran White
- Department of Emergency Medicine, Duke University, Durham, NC
| | - Mireya I Arreguin
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Lindsey Shughart
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia
| | - Cecilia Lara Chavez
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Dave V Glidden
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco
| | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia
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Ménétrey A, Landolt MA, Buettcher M, Neuhaus TJ, Simma L. Vaccine Hesitancy in Central Switzerland: Identifying and Characterizing Undervaccinated Children in a Pediatric Emergency Department. Pediatr Rep 2023; 15:710-721. [PMID: 38133432 PMCID: PMC10747840 DOI: 10.3390/pediatric15040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Vaccinations play an important role in the prevention of potentially fatal diseases. Vaccine hesitancy has become an important problem both in the public discourse and for public health. We aimed to identify and characterize this potentially unvaccinated or incompletely vaccinated group of children presenting to the pediatric emergency department (PED) of the tertiary children's hospital in central Switzerland, a region that has anecdotally been claimed as a hotspot for vaccine hesitancy. All patients presenting to the PED (N = 20,247) between September 2018 and September 2019 were screened for their vaccination status and categorized as incomplete, unvaccinated, or fully vaccinated in a retrospective cohort study. Some 2.6% (n = 526) visits to the PED were not or incompletely vaccinated according to age, or their vaccination status was unknown. Most of the children in the cohort were not critically ill, and the minority had to be hospitalized. Undervaccinated patients were overrepresented in rural areas. Of all cohort visits, 18 (3.4%) patients received opportunistic vaccination in the PED. No cases of vaccine-preventable diseases were observed. In summary, incompletely vaccinated and unvaccinated status was less frequent than initially expected. The PED may play a role in increasing vaccination coverage by providing opportunistic vaccinations.
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Affiliation(s)
- Anika Ménétrey
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
- Department of Neurology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Markus A. Landolt
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Michael Buettcher
- Pediatric Infectious Diseases Unit, Children’s Hospital Lucerne, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland;
- Department of Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Thomas J. Neuhaus
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Leopold Simma
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland
- Emergency Department, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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Hart R, Feygin Y, Kluthe T, Quinn KG, Rao S, Baumer-Mouradian SH. Emergency departments: An underutilized resource to address pediatric influenza vaccine coverage. Vaccine 2023; 41:7026-7032. [PMID: 37865600 DOI: 10.1016/j.vaccine.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Emergency department (ED) based influenza vaccine (IV) programs have been successful in adults; however, little is known about pediatric ED IV programs in terms of prevalence, feasibility, or successful implementation. AIMS To describe the reach and effectiveness of IV practices in pediatric EDs, and identify IV facilitators and barriers. METHODS We assessed, via cross-sectional survey of pediatric ED physicians, number of EDs offering IV to children, vaccines administered annually, and perceived facilitators/barriers to vaccination. The proportion of EDs offering IV is reported. Chi-square tests compared facilitators and barriers among high performers (≥50 IV/year), low performers (<50 IV/yr), and non-vaccinators. We calculated an area of missed effect for the number of children who could be vaccinated if non-vaccinating EDs offered IV. RESULTS Among 492 physicians from 166 EDs, 142 responded (representing 61 (37.3 %) EDs). Most EDs were in large, urban, academic, freestanding children's hospitals (Table 1). Only twenty-six EDs (44.3 %) offer ≥ 1 IV/yr. Seventeen (65.4 %) were low performers, five (19.2 %) high performers, and four (15.4 %) were model programs. High/model performers used establish workflows more commonly than lower performers (78 % vs. 33 %), although this was not statistically significant (p = 0.077). Common facilitators included: strong provider and administration buy-in, electronic health record facilitation, storage/accessibility, and having a leadership team/champion (Fig. 1). Non-vaccinators commonly perceived lack of these factors as barriers. Many (24/61, 39.3 %) EDs expressed interested in establishing or growing IV programs. Up to 18,250 unvaccinated children could receive IV annually if non-vaccinating EDs offered IV during influenza season. CONCLUSIONS Over half of EDs participating in the Pediatric Emergency Medicine Collaborative Research Committee do not currently offer pediatric IV. Addressing identified barriers/facilitators to develop IV programs in EDs has potential to improve vaccination rates, especially among minority and underserved children.
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Affiliation(s)
- Rebecca Hart
- Department of Pediatrics, Norton Children's and the University of Louisville School of Medicine, 571 S. Floyd Street, Suite 412, Louisville, KY 40202, United Sates.
| | - Yana Feygin
- Department of Pediatrics, Norton Children's and the University of Louisville School of Medicine, 571 S. Floyd Street, Suite 412, Louisville, KY 40202, United Sates
| | - Theresa Kluthe
- Department of Pediatrics, Norton Children's and the University of Louisville School of Medicine, 571 S. Floyd Street, Suite 412, Louisville, KY 40202, United Sates
| | - Katherine G Quinn
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, United Sates
| | - Suchitra Rao
- University of Colorado School of Medicine and Children's Hospital Colorado, United Sates
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Hart R, Feygin Y, Kluthe T, Quinn K, Rao S, Baumer-Mouradian SH. Emergency Departments: An Underutilized Resource for Expanding COVID-19 Vaccine Coverage in Children. Vaccines (Basel) 2023; 11:1445. [PMID: 37766122 PMCID: PMC10536917 DOI: 10.3390/vaccines11091445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
COVID-19 vaccine (CV) acceptance rates remain suboptimal in children. Emergency departments (EDs) represent a unique opportunity to improve vaccination rates, particularly in underserved children. Little is known about the presence or reach of CV programs in US EDs. We assessed, via a cross-sectional survey of pediatric ED physicians, the number of EDs offering CVs to children, the approximate numbers of vaccines administered annually, and the perceived facilitators/barriers to vaccination. The proportion of EDs offering CVs is reported. Chi-square tests compared facilitators and barriers among frequent vaccinators (≥50 CVs/year), infrequent vaccinators (<50 CVs/year), and non-vaccinators. Among 492 physicians from 166 EDs, 142 responded (representing 61 (37.3%) EDs). Most EDs were in large, urban, academic, freestanding children's hospitals. Only 11 EDs (18.0%) offer ≥1 CV/year, and only two (18.2%) of these gave ≥50 CVs. Common facilitators of vaccination included the electronic health record facilitation of vaccination, a strong provider/staff buy-in, storage/accessibility, and having a leadership team or champion. Barriers included patient/caregiver refusal, forgetting to offer vaccines, and, less commonly, a lack of buy-in/support and the inaccessibility of vaccines. Many (28/47, 59.6%) EDs expressed interest in establishing a CV program.
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Affiliation(s)
- Rebecca Hart
- Department of Pediatrics, Norton Children’s and the University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Yana Feygin
- Department of Pediatrics, Norton Children’s and the University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Theresa Kluthe
- Department of Pediatrics, Norton Children’s and the University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Katherine Quinn
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Suchitra Rao
- Department of Pediatrics (Infectious Diseases and Hospital Medicine), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Shannon H. Baumer-Mouradian
- Department of Pediatrics, Medical College of Wisconsin/Children’s Hospital of Wisconsin, Milwaukee, WI 53226, USA
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Reifferscheid L, Kiely MS, Lin MSN, Libon J, Kennedy M, MacDonald SE. Effectiveness of hospital-based strategies for improving childhood immunization coverage: A systematic review. Vaccine 2023; 41:5233-5244. [PMID: 37500415 DOI: 10.1016/j.vaccine.2023.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Hospital settings represent an opportunity to offer and/or promote childhood vaccination. The purpose of the systematic review was to assess the effectiveness of different hospital-based strategies for improving childhood vaccination coverage. METHODS A systematic search of multiple bibliographic databases, thesis databases, and relevant websites was conducted to identify peer-reviewed articles published up to September 20, 2021. Articles were included if they evaluated the impact of a hospital (inpatient or emergency department)-based intervention on childhood vaccination coverage, were published in English or French, and were conducted in high-income countries. High quality studies were included in a narrative synthesis. RESULTS We included 25 high quality studies out of 7,845 unique citations. Studies focused on routine, outbreak, and influenza vaccines, and interventions included opportunistic vaccination (i.e. vaccination during hospital visit) (n = 7), patient education (n = 2), community connection (n = 2), patient reminders (n = 2), and opportunistic vaccination combined with patient education and/or reminders (n = 12). Opportunistic vaccination interventions were generally successful at improving vaccine coverage, though results ranged from no impact to vaccinating 71 % of eligible children with routine vaccines and 9-61 % of eligible children with influenza vaccines. Interventions that aimed to increase vaccination after hospital discharge (community connection, patient education, reminders) were less successful. CONCLUSIONS Some interventions that provide vaccination to children accessing hospitals improved vaccine coverage; however, the baseline coverage level of the population, as well as implementation strategies used impact success. There is limited evidence that interventions promoting vaccination after hospital discharge are more successful if they are tailored to the individual.
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Affiliation(s)
| | - Marilou S Kiely
- Institut National de Santé Publique du Québec, Québec City, QC, Canada; Faculty of Medicine, Department of Social and Preventive Medicine, Québec City, QC, Canada; Centre de recherche du CHU de Québec, Québec City, QC, Canada
| | | | - Jackie Libon
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Simon EL, Crouse B, Wilson M, Muir M, Sayles S, Ramos C, Phelan MP. Evaluation of missed influenza vaccination opportunities in the emergency department. Am J Emerg Med 2023; 68:59-63. [PMID: 36933335 DOI: 10.1016/j.ajem.2023.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/19/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Seasonal influenza is associated with significant healthcare resource utilization. An estimated 490,000 hospitalizations and 34,000 deaths were attributed to influenza during the 2018-2019 season. Despite robust influenza vaccination programs in both the inpatient and outpatient setting, the emergency department (ED) represents a missed opportunity to vaccinate patients at high risk for influenza who do not have access to routine preventive care. Feasibility and implementation of ED-based influenza vaccination programs have been previously described but have stopped short of describing the predicted health resource impact. The goal of our study was to describe the potential impact of an influenza vaccination program in an urban adult emergency department population using historic patient data. METHODS This was a retrospective study of all encounters within a tertiary care hospital-based ED and three freestanding EDs during influenza season (defined as October 1 - April 30) over a two-years, 2018-2020. Data was obtained from the electronic medical record (EPIC®). All ED encounters during the study period were screened for inclusion using ICD 10 codes. Patients with a confirmed positive influenza test and no documented influenza vaccine for the current season were reviewed for any ED encounter at least 14 days prior to the influenza-positive encounter and during the concurrent influenza season. These ED visits were deemed a missed opportunity to provide vaccination and potentially prevent the influenza-positive encounter. Healthcare resource utilization, including subsequent ED encounters and inpatient admissions, were evaluated for patients with a missed vaccination opportunity. RESULTS A total of 116,140 ED encounters occurred during the study and were screened for inclusion. Of these, 2115 were influenza-positive encounters, which represented 1963 unique patients. There were 418 patients (21.3%) that had a missed opportunity to be vaccinated during an ED encounter at least 14 days prior to the influenza-positive encounter. Of those with a missed vaccination opportunity, 60 patients (14.4%) had subsequent influenza-related encounters, including 69 ED visits and 7 inpatient admissions. CONCLUSION Patients presenting to the ED with influenza frequently had opportunities to be vaccinated during prior ED encounters. An ED-based influenza vaccination program could potentially reduce influenza-related burden on healthcare resources by preventing future influenza-related ED encounters and hospitalizations.
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Affiliation(s)
- Erin L Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron General Ave., Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA.
| | - Bethany Crouse
- Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA; Cleveland Clinic Akron General, Department of Pharmacy, 1 Akron General Ave., Akron, OH 44307, USA
| | - Mackenzie Wilson
- Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA
| | - McKinzey Muir
- Emergency Services Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Stephen Sayles
- Emergency Services Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Chris Ramos
- Emergency Services Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Michael P Phelan
- Emergency Services Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
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Ford JS, Rouleau SG, Wagner JL, Adams CB, May LS, Parikh AK, Holmes JF. Assessment of a COVID-19 vaccination protocol for unhoused patients in the emergency department. Vaccine 2023; 41:1611-1615. [PMID: 36732166 PMCID: PMC9805895 DOI: 10.1016/j.vaccine.2022.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to evaluate the feasibility of implementing an emergency department (ED)-based Coronavirus Disease of 2019 (COVID-19) vaccination protocol in a population of unhoused patients. METHODS On June 10, 2021, a best practice alert (BPA) was implemented that fired when an ED provider opened the charts of unhoused patients and prompted the provider to order COVID-19 vaccination for eligible patients. We downloaded electronic medical record data of patients who received a COVID-19 vaccine in the ED between June 10, 2021 and August 26, 2021. The outcomes of interest were the number of unhoused, and the total number of patients vaccinated for COVID-19 during the study period. Data were described with simple descriptive statistics. RESULTS There were 25,871 patient encounters in 19,992 unique patients (mean 1.3 visits/patient) in the emergency department during the study period. There were 1,474 (6% of total ED population) visits in 1,085 unique patients who were unhoused (mean 1.4 visits/patient). The BPA fired in 1,046 unhoused patient encounters (71% of PEH encounters) and was accepted in 79 (8%). Forty-three unhoused patients were vaccinated as a result of the BPA (4% of BPA fires) and 18 unhoused patients were vaccinated without BPA prompting. An additional 76 domiciled patients were vaccinated in the ED. CONCLUSIONS Implementing an ED-based COVID-19 vaccination program is feasible, however, only a small number of patients underwent COVID-19 vaccination. Further studies are needed to explore the utility of using the ED as a setting for COVID-19 vaccination.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Sam G Rouleau
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Jenny L Wagner
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Christopher B Adams
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Larissa S May
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Aman K Parikh
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - James F Holmes
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA.
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Understanding Influenza and SARS-CoV-2 Vaccine Hesitancy in Racial and Ethnic Minority Caregivers. Vaccines (Basel) 2022; 10:vaccines10111968. [PMID: 36423063 PMCID: PMC9697963 DOI: 10.3390/vaccines10111968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: We compared influenza and SARS-CoV-2 vaccine hesitancy levels in Black, Hispanic, and White parents/caregivers and identified barriers and facilitators to vaccine acceptance. (2) Methods: This was a mixed methods study. A cross-sectional survey of ED caregivers presenting with children 6mo−18yo compared vaccine hesitancy levels among diverse caregivers. Six focus groups of survey participants, stratified by caregiver race/ethnicity and caregiver intent to receive SARS-CoV-2 vaccine, assessed facilitators and barriers of vaccination, with thematic coding using the Consolidated Framework for Implementation Research (CFIR). (3) Results: Surveys (n = 589) revealed Black caregivers had significantly higher vaccine hesitancy rates than White caregivers for pediatric influenza (42% versus 21%) and SARS-CoV-2 (63% versus 36%; both p < 0.05). Hispanic caregivers were more hesitant than White caregivers (37% flu and 58% SARS-CoV-2), but this was not significant. Qualitative analysis (n = 23 caregivers) identified barriers including vaccine side effects, lack of necessity, inadequate data/science, and distrust. Facilitators included vaccine convenience, fear of illness, and desire to protect others. (4) Conclusions: Minority caregivers reported higher levels of vaccine hesitancy for influenza and SARS-CoV-2. We identified vaccine facilitators and barriers inclusive of Black and Hispanic caregivers, which may guide interventions designed to equitably improve acceptance of pediatric vaccines.
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Bryan MA, Hofstetter AM, Ramos D, Ramirez M, Opel DJ. Facilitators and Barriers to Providing Vaccinations During Hospital Visits. Hosp Pediatr 2021; 11:1137-1152. [PMID: 34556537 DOI: 10.1542/hpeds.2020-004655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many children are undervaccinated at the time of hospital admission. Our objective was to explore the facilitators and barriers to vaccinating during hospitalization. METHODS We conducted qualitative interviews of parents, primary care pediatricians, emergency department (ED) physicians, and pediatric hospitalists. Parents of undervaccinated hospitalized children who were admitted through the ED were invited to participate. We used purposive sampling to identify physician participants. Semistructured interviews querying participants' perspectives on hospital-based vaccination were audiorecorded and transcribed. Parent demographics and physician practice characteristics were collected. Transcripts were analyzed for facilitators and barriers to vaccinating during acute hospital visits by using inductive content analysis. A conceptual framework was developed on the basis of the social ecological model. RESULTS Twenty-one parent interviews and 10 physician interviews were conducted. Of parent participants, 86% were female; 76% were white. Physician participants included 3 primary care pediatricians, 3 ED physicians, and 4 hospitalists. Facilitators and barriers fell under 4 major themes: (1) systems-level factors, (2) physician-level factors, (3) parent-provider interactional factors, and (4) parent- and child-level factors. Parent participants reported a willingness to receive vaccines during hospitalizations, which aligned with physician participants' experiences. Another key facilitator identified by parent and physician participants was the availability of shared immunization data. Identified by parent and physician participants included the availability of shared immunization data. Barriers included being unaware that the child was vaccine-eligible, parental beliefs against vaccination, and ED and inpatient physicians' perceived lack of skills to effectively communicate with vaccine-hesitant parents. CONCLUSIONS Parents and physicians identified several key facilitators and barriers to vaccinating during hospitalization. Efforts to provide inpatient vaccines need to address existing barriers.
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Affiliation(s)
- Mersine A Bryan
- Department of Pediatrics, School of Medicine .,Seattle Children's Research Institute, Seattle, Washington
| | - Annika M Hofstetter
- Department of Pediatrics, School of Medicine.,Seattle Children's Research Institute, Seattle, Washington
| | - Daniela Ramos
- Seattle Children's Research Institute, Seattle, Washington
| | - Magaly Ramirez
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Douglas J Opel
- Department of Pediatrics, School of Medicine.,Seattle Children's Research Institute, Seattle, Washington
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Baumer-Mouradian SH, Servi A, Kleinschmidt A, Nimmer M, Lazarevic K, Hanson T, Jastrow J, Jaworski B, Kopetsky M, Drendel AL. Vaccinating in the Emergency Department, a Model to Overcome Influenza Vaccine Hesitancy. Pediatr Qual Saf 2021; 6:e430. [PMID: 33855251 PMCID: PMC8032353 DOI: 10.1097/pq9.0000000000000430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Vaccine hesitancy and delays in vaccine administration time have limited the success of prior influenza vaccination initiatives in the pediatric emergency department (ED). In 2018-2019, season 1, this ED implemented mandatory vaccine screening and offered the vaccine to all eligible patients; however, only 9% of the eligible population received the vaccine. In 2019-2020, season 2, the team sought to improve influenza vaccination rates from 9% to 15% and administer over 2,000 vaccines to eligible ED patients. METHODS Key drivers included: identifying vaccine hesitancy, providing counseling, reducing administration delays, and developing reminders for vaccine administration. We tested interventions using plan-do-study-act cycles. We included discharged ED patients, age 6 months-18 years old, emergency severity index score 2-5, and no prior vaccine this season. Process measures included percent of patients screened, eligible, accepting the vaccine, and leaving before vaccination. Outcome measures were the percent of eligible patients vaccinated and the total number of vaccines administered. Vaccination time was the balancing measure. RESULTS We included 57,804 children in this study. Comparing season 1 to 2, screening rates (84%) and eligibility rates (58%) were similar. Vaccine acceptance rates improved from 13% to 22%, the proportion of patients leaving before vaccination decreased from 32% to 17%, and vaccination rates improved from 9% to 20%. Total vaccines administered increased from 1,309 to 3,180, and vaccination time was 5 minutes faster in season 2. CONCLUSIONS This ED influenza vaccination process provides a model to overcome vaccine hesitancy and can be adapted and replicated for any vaccine-preventable illness.
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Affiliation(s)
| | - Ashley Servi
- Children’s Hospital of Wisconsin, Milwaukee, Wis
| | | | - Mark Nimmer
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | | | | | - Jena Jastrow
- Children’s Hospital of Wisconsin, Milwaukee, Wis
| | | | - Matthew Kopetsky
- Department of Business Intelligence and Data Warehousing, Children’s Hospital of Wisconsin, Milwaukee, Wis
| | - Amy L. Drendel
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
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Chau S, Oldman S, Smith SR, Lin CA, Ali S, Duffy VB. Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting. Nutrients 2021; 13:nu13010223. [PMID: 33466705 PMCID: PMC7828782 DOI: 10.3390/nu13010223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children’s health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child’s activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (>90%) agreed the PALS was easy to complete, encouraging thought about their own/child’s behaviors. The child’s PALS responses appeared reasonable (fair-to-good child–parent intraclass correlations). Most children and parents (≥75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child’s weight or family’s food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.
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Affiliation(s)
- Sarah Chau
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Samantha Oldman
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Sharon R. Smith
- CT Children’s Medical Center, University of CT School of Medicine, Hartford, CT 06269-1101, USA;
| | - Carolyn A. Lin
- Communications Department, University of CT, Storrs, CT 06269-1101, USA;
| | - Saba Ali
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Valerie B. Duffy
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
- Correspondence: ; Tel.: +1-860-486-1997
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