Published online January 3, 2008
PEDIATRICS Vol. 121 Supplement January 2008, pp. S35-S45 (doi:10.1542/peds.2007-1115E)
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SUPPLEMENT ARTICLE


How Effectively Can Health Care Settings Beyond the Traditional Medical Home Provide Vaccines to Adolescents?

Stanley J. Schaffer, MD, MSa, John Fontanesi, MEd, PhDb, Donna Rickert, MA, PhDc,{dagger}, John D. Grabenstein, PhDd, Mitchel C. Rothholz, RPh, MBAe, Susan A. Wang, MD, MPHf, Daniel Fishbein, MDc for the Working Group on Complementary Settings

a Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
b Center for Management Science in Health, University of California School of Medicine, San Diego, California
c National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
d US Army Medical Command, Military Vaccine Agency, Falls Church, Virginia
e American Pharmacists Association, Washington, DC
f National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

OBJECTIVES. Our goal was to evaluate the capacity of various health care settings to supplement the activities of the traditional medical home by delivering vaccines to adolescents.

METHODS. A group of experts in the fields of adolescent-immunization delivery and the provision of preventive care in various health care settings summarized the available literature, considered setting-specific factors, and assessed the ability of various health care settings beyond the traditional medical home to conform to the immunization quality standards set by the National Vaccine Advisory Committee, report vaccination information for the quantitative assessment of vaccine-coverage rates, be likely to offer vaccines to adolescents, and be viewed by adolescents as acceptable sites for receiving vaccinations.

RESULTS. Seven candidate settings were evaluated: pharmacies, obstetrics-gynecology practices, sexually transmitted disease clinics, hospital emergency departments, family planning clinics, teen clinics, and local public health department immunization clinics. The panel concluded that all could safely provide vaccinations to adolescents but that vaccination efforts at some of the settings could potentially have a markedly greater impact on overall adolescent-immunization rates than could those at other settings. In addition, for adolescent-vaccination services to be practical, candidate settings need to have a clear interest in providing them. Conditional on that, several issues need to be addressed: (1) funding; (2) orienting facilities to provide preventive care services; (3) enhancing access to immunization registries; and (4) clarifying issues related to immunization consent.

CONCLUSIONS. With supporting health policy, health education, and communication, health care settings beyond the traditional medical home have the potential to effectively augment the vaccination efforts of more traditional settings to deliver vaccines to adolescents. These health care settings may be particularly well suited to reach adolescents who lack access to traditional sources of preventive medical care or receive fragmented medical care.

Key Words: adolescent vaccination • settings

Abbreviations: STD—sexually transmitted disease • CDC—Centers for Disease Control and Prevention • Ob-Gyn—obstetrics-gynecology • NVAC—National Vaccine Advisory Committee • ACOG—American College of Obstetricians and Gynecologists • ACEP—American College of Emergency Physicians • VFC—Vaccines for Children

Accepted Aug 22, 2007.