Development and Evaluation of a Clinical Practice Guideline to Promote an Evidence-based Approach to Vaccine Hesitancy in Primary Care

Abstract

The purpose of this project is to develop a clinical practice guideline with recommendations for vaccination and vaccine hesitancy in the pediatric setting. Routine vaccinations are given to children at recommended ages to decrease the incidence of, and prevent infectious disease. These vaccinations prevent diseases such as rotavirus, diphtheria, pertussis, tetanus, hepatitis B, haemophilus influenza type B, pneumococcal disease, polio, influenza, measles, mumps, rubella, varicella and hepatitis A. There are currently no guidelines that combine evidence-based interventions to increase vaccination rates, the recommended vaccine schedule, specific information on each vaccination, its side effects, and ingredients of each vaccination. By developing this guideline, it is hoped that pediatric providers will be able to effectively approach the caregivers of vaccine-aged children with evidence based information about vaccination, and be able to address specific concerns regarding vaccines. The available literature was formally evaluated using GRADEpro software. These results were put into the BRIDGE-Wiz (Building Recommendations in a Developer ’s Guideline Editor) software to create clear, concise, key action statements for the guideline. There were five recommendations that were created based on the literature review which include assessing parental concerns regarding vaccination at each visit, educating parents on vaccination, each vaccine, at each visit and when concerns arise, recommending vaccinations during each visit and when the opportunity arises, recommending pre-scheduling vaccination appointments, and implementing a reminder/recall system when vaccinations are due or past due. There were also informational tables created for provider reference that include important information regarding vaccines. The first table includes each vaccination, the disease it prevents, and the risk of the disease vs the risk of the vaccination. The second table includes the vaccine ingredients that commonly cause concern, and information to address those concerns. The guideline can be used in pediatric primary care to guide interventions to increase the uptake of vaccinations, and as a tool for providers to use while educating parents on specific vaccinations. The guideline was formally evaluated using the AGREE II tool by three experts in the field of pediatric primary care. All three of the reviewers stated that they would recommend the guideline for use in the pediatric setting.