Missed well-child visits a surprising culprit for inadequate childhood vaccination rates


A recently released Health of America Report, sponsored by the Blue Cross Blue Shield Association, in partnership with HealthCore and Blue Health Intelligence, demonstrates that early childhood vaccination rates are on the rise nationwide. What it also shows, however, is that there is still room for improvement.

Rhode Island fares well when it comes to early-childhood vaccinations -- 80.1 percent of children under two and a half years old receive CDC-recommended vaccines with the national rate at 77 percent. (The report focuses on commercially insured children.) The 80.1 percentage places Rhode Island in the top 10 plans nationally. This is a significant achievement, but you have to ask, “What about the other 20 percent?”

Despite improvements, some vaccines remain below the CDC- and WHO-recommended levels to ensure herd immunity – when a significant portion of population is vaccinated, providing a measure of protection for those who have not developed immunity. For example, diphtheria may need vaccination rates as high as 86 percent, and pertussis and measles as high as 94 percent. The vaccine rates for these diseases are currently 83 percent and 91 percent nationally, respectively. Herd immunity is of vital importance for protecting babies too young for certain vaccines or those who can’t medically receive them.

So, how do we close the 20 percent gap? If you follow the news, you might think that parent-refusal accounts for missed vaccinations. In reality, the real culprit is missed well visits. Missed well-child visits were identified as the reason for under vaccination 62 percent of the time. Among these same under-vaccinated children, documented parental/guardian refusal was identified only 6 percent of the time.

Addressing some of the underlying issues for these missed well visits is crucial to improving the rates of young children receiving life-saving vaccines. Some of these barriers may include:
• Lack of transportation.
• No primary care provider selected or identified. Families may rely on urgent care only.
• Misinformation about the cost of well visits. Under the provisions of the Affordable Care Act, health insurers are required to cover all recommended well-child visits and screenings.
• Parent unable to miss work to take their child to an appointment.
• Lack of education on the importance of pediatrician visits to screen for a variety of issues or learn how to proactively manage chronic illness. Children don’t only need to see the doctor when they are sick!

Working toward improved awareness, education and compliance with the recommended well-child visits could improve vaccination rates. And, we’re making progress. Some pediatric practices have new ways to improve adherence, including text message reminders for checkups and age-specific health messages. Some practices have formed  teams that include nurses, health coaches and medical assistants who spend extra time educating families and conducting screening tests to allow time-crunched pediatricians to focus on the most important issues in visits that may last 15 to 30 minutes.

BCBSRI is committed to continuing to work with our members, our provider partners and our Rhode Island community to find ways to better connect families with the pediatric well visits that are so important to good health. BCBSRI offers a case management team eager to help members find available resources or solutions to issues that prevent them from connecting with a primary care provider. The team can also provide up-to-date information on which providers are accepting new patients. Members can reach a team member by calling 401-459-CARE (2273). For more information on BCBSRI case management, visit http://www.rhodeahead.com/live/nurse.

Katherine Dallow, M.D., MPH, is vice president of clinical affairs at BCBSRI.

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