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Survey Benefit/Risk InformationSubject: Survey Benefit/Risk Information - To identify current practices of childhood vaccine
Date: Tue, 13 Feb 2001 23:48:43 -0800
E-NEWS FROM THE NATIONAL VACCINE INFORMATION CENTER
BLFisher Note: This survey confirms the anecdotal evidence NVIC has collected for 15 years: most doctors are not complying with the safety provisions of the National Vaccine Injury Act of 1986. Those provisions mandated that doctors provide parents with vaccine benefit and risk information prior to vaccination of children and record and report vaccine adverse events. If there is physician reluctance to discuss vaccine risks with parents and only 10 percent of doctors are willing to discuss the vaccine injury compensation program, it is likely that physicians are not reporting vaccine adverse events to the Vaccine Adverse Event Reporting System (VAERS). Most parents reporting their child's vaccine reaction to NVIC state that their doctors refuse to make a vaccine adverse event report to VAERS. NVIC supports legal sanctions against physicians who refuse to provide vaccine risk information to parents or to record and report vaccine adverse events as mandated under the 1986 law, such as removing their right to vaccinate.
Pediatrics 2001 Feb;107(2):E17
Here are the results of a recent survey conducted by the Departments of Pediatrics and Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana regarding the practice of risk/benefit communication.
Results. Sixty-nine percent of pediatricians and 72% of family physicians self-reported their offices gave parents the Centers for Disease Control and Prevention Vaccine Information Statement, while 62% and 58%, respectively, gave it with every dose. In ~70% of immunization visits, physicians and nurses reported initiating discussion of the following: common side effects, when to call the clinic and the immunization schedule. However, physicians reported rarely initiating discussion regarding contraindications (<50%) and the National Vaccine Injury Compensation Program (<10%). Lack of time was considered the greatest barrier to vaccine risk/benefit communication. Nurses reported spending significantly more time discussing vaccines with parents than pediatricians or family physicians (mean: 3.89 vs 9.20 and 3.08 minutes, respectively). Both physicians and nurses indicated an additional 60 to 90 seconds was needed to optimally discuss immunization with parents under current conditions. Stratified analysis indicated nurses played a vital role in immunization delivery and risk/benefit communication. To improve vaccine risk/benefit communication, 80% of all providers recommended a preimmunization booklet for parents and approximately one half recommended a screening sheet for contraindications and poster for immunization reference. The learning method most highly endorsed by all providers was practical materials (80%). Other desirable learning methods varied significantly by provider type.
Conclusions. There was a mismatch between the legal mandate for Vaccine Information Statement distribution and the actual practice in private office settings. The majority of providers reported discussing some aspect of vaccine communication but 40% indicated that they did not mention risks. Legal and professional guidelines for appropriate content and delivery of vaccine communication need to be clarified and to be made easily accessible for busy private practitioners. Efforts to improve risk/benefit communication in private practice should take into consideration the limited time available in an office well-infant visit and should be aimed at both the nurse and physician.
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-------------------------------------------------------- Sheri Nakken, R.N., MA Vaccination Information & Choice Network, Nevada