FROM PEDIATRICS

The number of physicians agreeing to parental requests to spread out vaccines tripled between 2009 and 2012 despite safety concerns, a survey shows.

Writing in Pediatrics, the authors said some parents were requesting delays to their child’s vaccination schedules, believing it was safer (Pediatrics 2015 [ doi: 10.1542/peds.2014-3474 ]).

It was unknown how these requests were being handled by pediatric and primary care physicians said Dr Allison Kempe from the Children’s Hospital Colorado in Aurora, and her associates.

The survey mailed to 534 pediatricians and family physicians found that in a typical month 93% received parental requests to spread out vaccines. Results showed that 37% “often or always” agreed to the request and 37% “sometimes” agreed. This was in stark contrast to a similar survey conducted in 2009 that showed 13% “often or always” agreed to the request.

“This shift may reflect changes in the beliefs of physicians about what is effective in working with hesitant parents, adherence to published recommendations about how to build trust with vaccine hesitant parents, or simply a pragmatic reaction to the amount of time it takes to discuss parents’ concerns in the context of a busy practice setting,” the study authors wrote.

The rise in granting requests to delay vaccines was despite 87% of respondents saying they thought parents were putting their children at risk of disease.

The reasons physicians gave for agreeing to requests included building trust with families (82%) and fear that families might leave their practice (80%) if they declined the request.

Dealing with parental requests was time consuming, the survey showed, with roughly half of physicians saying they spent more than 10 minutes in discussions with parents who had vaccine concerns.

This could equate to more than half of a well-child visit, shortchanging other important areas of child development, the authors said.

Physicians reported using many strategies in response to requests to deviate from vaccine schedules but most had a “relatively bleak” perception of their effectiveness, the researchers said.

“Our study points out the need for an evidence base to guide primary care physicians in efforts to increase timely vaccination,” they concluded.

Conversations around vaccinations needed to start early in pregnancy “because [recent data suggests] that is when vaccine decision-making begins, especially for parents who are hesitant about vaccines,” they added. Also, “amplifying the voice of the vast majority of parents who do follow vaccination recommendations in public messaging and in settings such as preschools and schools could be a powerful tool .”

The study was funded by the Centers for Disease Control and Prevention. The authors had no relevant financial disclosures.

pdnews@frontlinemedcom.com

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