Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery

摘要

Objectives. We compared completion rates for adolescent immunization series administered at school-based health centers (SBHCs) to completion rates for series administered at community health centers (CHCs) within a single integrated delivery system. Methods. We performed a retrospective analysis of data from an immunization registry for patients aged 12–18 years. Patients were assigned to either an SBHC or a CHC during the study interval based on utilization. We used bivariate analysis to compare immunization series completion rates between the 2 groups and multivariate analysis to compare risk factors for underimmunization. We performed subanalyses by ages 12–15 years versus ages 16–18 years for human papillomavirus (HPV) and for the combination of HPV; tetanus, diptheria, and pertussis (Tdap); and tetravalent meningococcus virus. Results. SBHC users had significantly higher completion rates ( P 1 , 2 Immunizing children and adolescents presents challenges within our current system of health care delivery. This is true for all immunizations but particularly so for the administration of multidose vaccine series. Numerous authors have identified systemic, parental, and patient barriers to vaccine administration. 3 – 8 School-based health centers (SBHCs), primary care clinics located in schools, have been shown to improve rates of child and adolescent immunization. 9 , 10 SBHCs are an optimal model for delivery of adolescent primary care around the country, and many SBHCs currently deliver immunizations. 11 However, little is known about the success of this model in completing vaccine series. In a retrospective analysis, we examined immunization series completion rates of children and adolescents aged 12 to 18 years within an integrated health care system that delivered care via both SBHCs and community health centers (CHCs). We compared the completion rates of patients who received care primarily through SBHCs with the completion rates of patients who received care primarily through CHCs.