Docs spread out vaccine schedule despite concerns

More than 90% of primary care physicians (PCPs) surveyed in a new study say that in a typical month they encounter parental requests to spread out the recommended vaccination schedule for their children by reducing the number of vaccines given simultaneously or postponing some vaccines until an older age. Most agree to do so at least sometimes despite reservations.

Related: 2015 pediatric immunization schedule issued

The e-mail and mail survey questioned a nationally representative sample of 815 pediatricians and family physicians from June 2012 through October 2012. Of the 534 (66%) doctors who replied, 93% said that some parents of children aged younger than 2 years asked them to spread out the vaccination schedule, and 21% said that 10% or more of parents asked. Data suggest that more parents have been opting to deviate from the recommended vaccine schedule over the past decade.

Seventy-four percent of the surveyed physicians agreed to parental requests either often or always (37%) or sometimes (37%) even though most believed that it was important to give all vaccines in the primary series on time (92%) and that spreading out vaccinations was putting the children at risk of disease (87%) or causing them more pain (84%). Only 18% said that they would dismiss from their practice families who wanted to spread out the vaccine schedule: 2% often or always, 4% sometimes, and 12% rarely.

Most respondents believed that agreeing to spread out vaccinations would build trust with families (82%) and that not doing so might cause families to leave the practice (80%). Thirty-five percent believed that granting parental requests to spread out vaccines gave the family a mixed message, however; 40%, especially pediatricians, said that the issue had lessened their job satisfaction.

Read more: Teens & the HPV vaccine

About half of all respondents, and 57% of pediatricians, reported spending at least 10 minutes during well-child visits discussing vaccination concerns with hesitant parents, potentially short-changing other topics. Although physicians used a variety of strategies to respond to parental requests for alternate vaccine schedules, they weren’t optimistic about the effectiveness of those strategies in persuading parents to vaccinate their children according to recommendations. Overall, few doctors considered any of the responses to be “very effective,” although they deemed many strategies to be “somewhat effective.”  

The researchers conclude that their study results highlight “the need for an evidence base to guide [PCPs] in efforts to increase timely vaccination.” They also advocate measures to augment the limited communication that is possible at well-child visits, citing the time consumed by discussions with vaccine-hesitant parents, the inability to charge for additional visits devoted exclusively to such discussions, and the many other issues that PCPs must address.