TABLE 1

Barriers and Solutions to Adolescent Immunizations

CategoryBarriersaSolutions
Adolescent or familyNo medical homeEducation from multiple sources
No preventive visitEducation, reminders from many sources
Costs (for health care visit or vaccine)Health insurance (eg, increase VFC coverage until 21 y)
Schedule; unaware of need for vaccineVaccination cards, patient reminders
Safety concernsEducation from multiple sources
Consent and confidentiality issuesEducation from multiple sources
Health beliefs (importance of vaccines)Education from multiple sources
Other activities having higher priorityEducation from multiple sources
Pain of vaccines and multiple shotsPharmacologic and complementary care
Health care providersComplicated agenda for adolescent preventive services (many issues to cover)Standing orders for vaccinations; practice-level changes
Missed opportunities for vaccinationPolicy changes with self-audits, office guidelines, standing orders
Schedule: not recommending annual visitsPolicy changes (provider groups)
Implement reminder/recall systems, link with registriesImplementing systems; link with registries
Not using recommended strategiesPractice-level changes
Lack of quality assurance process within the practiceComprehensive Assessment Software Application for adolescent vaccines; health maintenance organizations; quality improvement
CostsVFC program and insurance policies
Health beliefsProvider education
Consent and confidentiality issuesProvider education (eg, about laws)
SystemNo medical home for many adolescentsIntegrate medical home with other sites, insurers; outreach
No preventive visitIntegrate medical home with other sites, insurers; outreach
No tracking of individuals needing vaccinesRegistries, managed care, health systems universal vaccines
Costs for health care or vaccinesVFC program for adolescent vaccines (until 21 y)
Scattering of health care across sitesManaged care and other systems
Lack of uniformity of state vaccination lawsSchool vaccination laws and school-entry requirements; legal counsel
Lack of uniformity of interpretation of lawsClarification of consent
Lack of uniformity of guidelinesProvider groups and state recommendations
Insufficient education about vaccinesSchool-based education Vaccine Information System forms and other materials
  • a Barriers are ordered within each category according to importance, as measured by author and expert consultant rankings. These barriers are applicable to the medical home but may also apply to vaccinations received elsewhere.