Addressing parental concerns about pain during childhood vaccination: Is there enough time to include pain management in the ambulatory setting?

Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.
The Clinical journal of pain (Impact Factor: 2.53). 09/2011; 28(3):238-42. DOI: 10.1097/AJP.0b013e31822af81c
Source: PubMed


Pain from vaccine injections remains undertreated, despite the availability of numerous pain-relieving strategies. Healthcare providers report lack of time within current office workflows as a major barrier to routine pain management. The objective was to document the total time involved in outpatient vaccine appointments to test the hypothesis that offering pain-relieving strategies can be practically implemented when considering the element of time to vaccine injection.
Prospective naturalistic study in 8 urban outpatient primary care clinics (4 pediatric and 4 family practice) in Toronto. For 48 to 59 consecutive childhood vaccination appointments at each site, child waiting time from clinic arrival until first vaccine injection was tracked.
Altogether, 405 vaccine appointments were included. The median age of the child undergoing vaccination was 12 months. The mean (SD) time from clinic arrival until first vaccine injection was 41.6 minutes (20.9), with a range of 7 to 132 minutes. Linear regression identified a significant (P<0.05) difference according to clinic [ranging from 19.4 min (6.5) to 57.5 min (20.2)] and number of family members in the appointment [ranging from 40.6 min (21.0) for an appointment in the index child only to 50 min (14.3) for an appointment in the index child and 2 other family members].
Contrary to healthcare provider perceptions, the timing of outpatient childhood vaccine appointments allows for the inclusion of pain management interventions. Efforts should now focus on educating healthcare providers and parents about the value of pain management and how to implement evidence-based strategies.

18 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Needle fears are a documented barrier to immunization in children and adults. There is a paucity of data, however, regarding the prevalence of needle fears and their impact on immunization compliance. In this cross-sectional survey, a convenience sample of parents (n=883) and children (n=1024) attending a public museum in Toronto, Canada answered questions about needle fears and non-compliance with immunization due to needle fear. Altogether, 24% of parents and 63% of children reported a fear of needles. Needle fear was the primary reason for immunization non-compliance for 7% and 8% of parents and children, respectively. Interventions aimed at improving education about, and access to, analgesic interventions during immunization injections performed in childhood are recommended in order to prevent the development of needle fears and vaccine non-compliance.
    Vaccine 05/2012; 30(32):4807-12. DOI:10.1016/j.vaccine.2012.05.011 · 3.62 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ahola Kohut S, Hillgrove Stuart J, Stevens B, Gerwitz-Stern A. Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD006275. DOI: 10.1002/14651858. CD006275.pub2. Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration
    Evidence-Based Child Health A Cochrane Review Journal 11/2012; 7(6). DOI:10.1002/ebch.1884
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate knowledge uptake from a parent-directed factsheet about managing pain during infant vaccinations, and the added influence of a pre-test. Solomon 4-group randomized controlled trial. New mothers hospitalized after the birth of an infant were randomized to 1 of 4 groups: two included the intervention (factsheet about pain management) and two included the control (information on another topic). A pre-test was given to one intervention and one control group. Following maternal review of allocated information, post-tests were administered in all groups. Both control groups received the information after post-testing. A follow-up telephone survey after 2 months measured knowledge retention and utilization of pain management interventions. 120 mothers participated (July, 2012 - February, 2013); demographics did not differ among groups. The 2 factsheet groups demonstrated more knowledge (P<0.05) about effective pain management [mean without pre-test: 5.6 (SD=2.0); with pre-test: 6.9 (1.6)] compared to the two control groups [without pre-test: 3.2 (2.2); with pre-test: 3.4 (2.5)] immediately after review; and the factsheet and pre-test group scored higher than the factsheet only group. In groups with a pre-factsheet baseline, knowledge was higher at follow-up compared to baseline. Follow-up knowledge and utilization of pain management interventions did not differ among groups. The factsheet led to acute gains in knowledge and knowledge gains persisted after 2 months. Acutely, knowledge was bolstered by the pre-test. These results can be used to guide future research and implementation of the factsheet.
    The Clinical journal of pain 11/2013; 30(11). DOI:10.1097/AJP.0000000000000051 · 2.53 Impact Factor
Show more