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

Abstract

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.

Interventions to Improve Adolescent Vaccination

“…115,120 Multiple barriers have been identified, including reimbursement for vaccination and tracking of provided vaccines. 115,121,122 However, given the proven success of pharmacists as vaccinators of adults, finding ways to implement a similar approach for adolescent vaccination may be a fruitful area for future study. Educational interventions directed at parents and adolescents may not be hugely effective.…”

The Role of Pharmacists in Caring for Young People With Chronic Illness

“…Studies have also, however, highlighted the potential for community pharmacists to break confidentiality -when, for example, pharmacists might contact a parent before dispensing contraception to minors 4 . In relation to vaccination, there has been recognition of the potential of the community pharmacy setting as a 'unique resource' to increase adolescent immunization rates 5 -but the need to increase pharmacists' experience with young people was noted.…”

173. Does Immediate Access to Birth Control Help Prevent Pregnancy? A Comparison of Onsite Provision Versus Off-Campus Referral for Contraception at Two School-Based Clinics

“…The medical home model implemented in a teen clinic or family planning clinic setting can be an efficient way to deliver both well and sick child care for communities with large numbers of uninsured youth. 23 Creating a medical home within a school venue can be an efficient way not only to initiate and complete series of vaccinations, for instance, but also to involve parents through the consenting process required for the care of minors. Using the medical home model can also provide a forum for the detection and treatment of sexually transmitted infections, the prevention and screening of HIV, and the prevention of unintended pregnancy through contraceptive dispensing and counseling in this at-risk group.…”