Patient vaccination cards can boost compliance and rates

Giving patients vaccination records for their children can help boost up-to-date vaccination rates across all racial and ethnic groups. But giving parents a shot card also increases rates of over-vaccination in most groups.

"Shot cards are convenient methods to convey information between providers and between health care facilities," said Paul Darden, MD, Medical University of South Carolina in Charleston, in a presentation yesterday at the PAS Annual Meeting. "Shot cards are also a useful way to give parents more control over vaccination of their children. We have seen that using shot cards increases the rate of up-to-date even if there is only one provider involved."

Dr. Darden analyzed public use files from National Immunization Surveys from 1993 to 2003, which include households with children between 19 and 35 months of age. Overall, 47% of households held their own vaccination records, but there was significant variation by race.

Among whites, 47% of households kept a shot card. That compared to 62% among Hispanics, 40% for African-Americans, and 52% for other racial or ethnic groups. The overall up-to-date rate was 74.8%, but children who had a shot card were more likely to be up-to-date on their vaccinations: 78.3%, versus 71.7% up-to-date for children without a shot card.

Whites showed the highest rate of up-to-date vaccinations with a shot card, 79.7% compared to 72.0% in households without a shot card. Hispanics jumped from 68.8% up-to-date without a shot card to 73.3% up-to-date with a card. African-Americans increased from 64.4% to 74.0%.

Researchers also found a correlation between the use of shot cards and over-vaccination. The total over-vaccination rate was 4.8%. In whites, 3.9% of children who did not have a shot card were over-vaccinated, compared to 5.5% over-vaccination among those with a shot card. A similar increase was seen among Hispanics - 4.8% over-vaccination without a shot card and 8.1% with a shot card - and among African-Americans - 4.8% over-vaccination without a shot card and 5.0% without. Only the "other" group moved against the trend, with 7.2% of children without a shot card being over-vaccinated, compared to 5.8% with a shot card.

Dr. Darden said the association between shot cards and over-vaccination is unclear. It may be linked to incomplete or illegible information on an existing shot card, which prompts a second provider to give another vaccination to ensure coverage.

"We are not talking about cause and effect relationship between shot cards and over-vaccination, just an association," he said. "What is clear is that, while there is a cost to shot cards in terms of over-vaccination, the data suggest that shot cards should be used to increase up-to-date vaccinations in our pediatric population."