AAP survey tracks vaccine administration practices

from the AAP Divisions of Health Care Finance and Practice and Health Policy Research

Most pediatricians communicate the benefits and risks of vaccines to their patients and ensure informed consent for immunizations. A large proportion, however, do not discuss, distribute or document the provision of such information, or obtain signed consent, each time a vaccine is administered, according to an AAP Periodic Survey of Fellows.

The survey asked pediatricians about their communication and documentation of the risks/benefits of each of the recommended vaccines for which Vaccine Information Statements (VIS) were available at the time of the survey. Those vaccines include hepatitis B, DTaP/DTP, Haemophilus influenza type b, IPV/OPV, MMR, varicella and pneumococcal conjugate vaccine.

Pediatricians’ responses regarding vaccine risk/benefit discussion, distribution and documentation of VIS, and consent for immunization were similar across vaccines. About one-half of pediatricians (50% to 55% depending on the vaccine) verbally discuss the risks/benefits of each vaccine with every dose administered (see chart); more than one-fourth (25% to 29%) do so only at the first dose, and about 20% only sometimes discuss the risks/benefits. Fewer than 3% say they never discuss the risks/benefits of a vaccine.

Nearly all pediatricians distribute VIS at some point during the vaccine series. However, about six out of 10 pediatricians report distributing VIS with every dose of each vaccine. About one-fourth do so with the first dose only, about 10% sometimes distribute VIS and fewer than 6% say they never distribute the information statements. More than half of pediatricians (about 55%) say they document the provision of VIS at every dose for each vaccine and about 11% do so at the first dose of a vaccine only. While 16% sometimes document provision of VIS, between 17% to 20% say they never do so.

More than one-third of pediatricians (33% to 37%) document the parent’s verbal consent in the patient’s record at every dose of each vaccine and about 20% sometimes do so, while more than four out of 10 pediatricians say they never document verbal consent (44% to 46% depending on the vaccine).

More than seven out of 10 pediatricians report they obtain the parent’s signature as evidence of consent at every dose of each type of vaccine; about 8% sometimes do so and approximately 20% say they never obtain parents’ signature.

Vaccine administration practices vary as a function of practice setting, practice area and region of the country. For example, pediatricians in group practices (45%) are less likely than pediatricians in hospital/clinic practices (59%) or solo practices (51%) to say they discuss vaccine risks/benefits with every dose of at least six of the seven vaccines (p<.01). Pediatricians practicing in rural areas and those in the Midwest and South are more likely to distribute VIS at every dose than are pediatricians practicing in other areas (70% rural vs. 55% inner city vs. 64% other urban vs. 59% suburban, p<.05) or regions of the country (72% Midwest vs. 68% South vs. 54% West vs. 49% Northeast, p<.001). practitioners in rural areas (65%) also are more likely to document provision of VIS with every dose of each vaccine than are practitioners in urban inner cities (43%), other urban areas (58%) or suburban areas (54%) (p<.01).

Periodic Survey #48 was mailed to a random sample of 1,622 AAP members in the United States between February and May 2001, with a response rate of 64%. Responses are based on 815 pediatricians who offer age-appropriate immunizations to all or some of the children in their practices. These findings were presented at the May 2002 Pediatric Academic Societies annual meeting.

Information regarding communicating risk and
documenting vaccine administration is available at
www.aapnews.org/cgi/content/full/16/4/14. Vaccine
documentation forms are available from the AAP
Customer Service Center at (866) THE-AAP1, (866)
843-2271.