Vaccine refusal impacts other routine care

Vaccine refusal is a real challenge to many pediatricians today, with up to 13% of parents requesting alternative vaccination schedules and roughly 3% refusing them altogether. Now, a new study from a team of military physicians examines the effects of vaccine refusal on the relationship between pediatricians and their patients.

The report notes that although parents who refuse vaccines or request alternative schedules report a high level of trust in their pediatrician, there are many other reasons for vaccine refusal or hesitation, including concerns about the vaccines themselves and a lack of information to make informed decisions.

Pediatricians are feeling the heat as well, reporting distress when faced with requests for alternative schedules or parents refusing vaccines for their children, and some have even become less satisfied in their work as a result, the researchers say.

‘Firing’ patients who refuse or whose parents refuse vaccination has become more common, with up to 20% of physicians reporting in recent polls that they have dismissed families for refusing vaccines, according to the report. “Arguably, the fractured ‘trust relationship’ between pediatric providers and families on this issue makes vaccine refusal or requests for alternate schedules a divisive issue,” the report notes. “It stands to reason that the act of vaccine refusal and the discussion that ensues changes the dynamics of the relationship between parent and pediatric provider.”

Physician/parent relationships

The goal of this study, according to the authors, is to examine how requests for alternate vaccine schedules to complete refusal impact subsequent visits to the pediatrician’s office and the relationship between the physician and his/her patients, as well as how vaccine refusal or an alternate schedule impacts a patient’s compliance with other recommended interventions.

The study was conducted by reviewing the charts of children aged 0 to 4 years assigned to an Army hospital in West Point, New York, between 2009 and 2013. Researchers found that of nearly 400 patients overall, 81 patients during this period did not adhere to the recommended routine vaccine schedule (RVS), and 59 were excluded from routine schedules for medical reasons or because of previous or alternate vaccination at another location. Of those 22 remaining, 68% requested alternative schedules, and 32% refused all vaccinations, according to the report.

The team found that patients who followed the RVS made significantly more visits to their healthcare provider than those who refused vaccines or used alternate schedules. When researchers compared visit types across both groups, there was no real difference in the number of acute or emergency department (ED) visits, but children who were on alternate or nonexistent vaccination schedules made significantly fewer routine visits to their physician than those on an RVS.

The researchers note that although their study was consistent with others in showing that complete vaccine refusal is rare and that more parents defer to alternative schedules above complete refusal, there is still the issue of the lower frequency of regular physician visits in this group. Military rank was used to mimic socioeconomic class in the study, and researchers found that white individuals whose families belonged to higher ranks within the military were most likely to refuse vaccines or request alternate schedules.

“This is consistent with previous studies indicating parents that refuse vaccines or prefer alternate schedules tend to be white, well educated, and of a higher socioeconomic status,” the researchers note.

The report states that the results of the study support the team’s hypothesis that families who refuse routine vaccinations are less likely to receive routine care than their fully vaccinated peers. Parents, like pediatricians, struggle with this issue, the report says, revealing that parents who refuse vaccines report spending time constantly reevaluating their decision.

Whereas routine care may decline in families who refuse vaccination or request alternate schedules, the researchers point out that this doesn’t necessarily signal a loss of trust in physicians.

“Contrary to our hypothesis, families refusing the RVS demonstrate a reliance on the medical profession during times of significant concern or perhaps crisis as demonstrated by similar attendance for both acute and ED visits as compared to their fully vaccinated peers,” the researchers write. “Our study demonstrates that in times in which there is crisis or concerning symptoms, families despite vaccination status turn to medical providers. Trust between provider and patient is built with such interactions. Providers can capitalize on these encounters to emphasize the importance of the routine immunization schedule.”

The research team suggests more study is needed to develop communication and education tools that can be used in acute care settings to target these families and encourage adherence to an RVS.

“Understanding the long-term vaccination behavior of these families would provide greater insight as to what interventions might be most effective in communicating the importance of childhood vaccination,” according to the study authors. “Families who refuse to follow the RVS are missing opportunities to interact with their providers, as well as the other important screenings and preventive care that is provided during these visits. As a result, it is important to develop a better understanding of which factors are associated with making fewer routine well-care visits in families that refuse to follow the RVS.”