Protecting Infants through Tdap Vaccination during Pregnancy: A Qualitative Analysis of the Perspectives of Obstetrician-Gynecologists Open Access
Mehrotra, Arpita (2016)
Abstract
Background: Pertussis or whooping cough is an acute and contagious pulmonary disease that has becoming an increasingly widespread problem in the United States. Despite the disease being vaccine preventable, newborns and infants show the highest mortality rate across the nation. In response to this, the CDC's Advisory Committee on Immunization Practices (ACIP) has made several recommendations over the years. Pursuant to ACIP's most recent recommendation in 2013 for receipt of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during the third trimester of every pregnancy, we sought to assess physician attitudes, perspectives, and clinical practices regarding Tdap administration for pregnant patients. Our overarching aim was to inform new strategies to improve patient-physician communication and physician administration of the Tdap vaccine in in order to ultimately reduce pertussis related morbidity and mortality among infants.
Methods: In-depth interviews were conducted with a national sample of forty obstetrician-gynecologists (OB/GYNS) in two discrete phases. Analyses of the transcripts were performed using the grounded theory approach using deductive and inductive coding strategies followed by intercoder reliability assessment.
Results: Four major themes emerged: (1) Pertussis susceptibility was perceived as a low health threat (2) Physicians recognize Tdap benefits associated with administration during pregnancy; (3) Most physicians recommend Tdap to their patients, but variation was observed in their clinic administration and stocking practices; and (4) A lack of insurance reimbursement and storage logistics can serve as barriers to practice administration of Tdap during pregnancy; patient vaccine refusal was cited by physicians as an occasional barrier.
Conclusions: Our findings indicate that while most OB/GYNs recognize the benefits of Tdap and recommend vaccination during pregnancy, barriers such as insurance reimbursement and financial barriers outweigh perceived benefits for those OB/GYNs choosing not to stock and administer Tdap to pregnant patients. Future recommendations to address these concerns include 1) structural support for administration of Tdap in OB/GYN practices; 2) CME-equivalent educational interventions that address management techniques, vaccine coding, and other relevant information; and 3) interventions to assist physicians in understanding and communicating the importance of Tdap vaccination during pregnancy.
Table of Contents
Chapter 1: Introduction………………………………………………………..1
Chapter 2: Literature Review………………………………………………….7
Chapter 3: Methods…………………………………………………………….20
Chapter 4: Results………………………………………………………………25
Chapter 5: Discussion and Recommendations…………………………..53
References………………………………………………………………………..62
Appendix A: IRB Determination…………………………………………….65
Appendix B: Emergent Themes Table……………………………………...67
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Protecting Infants through Tdap Vaccination during Pregnancy: A Qualitative Analysis of the Perspectives of Obstetrician-Gynecologists () | 2018-08-28 11:53:41 -0400 |
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