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Protecting pint-sized patients

UT Medicine physicians improve vaccination rates among children

April 2013

by Sheila Hotchkin

Parents have a lot on their minds. Some are learning to balance an infant’s many needs with life’s other obligations, even while celebrating each sign of a healthy baby: the first laugh, words, steps and more. Other parents are racing after an active toddler or facing the rapid-fire questions of a preschooler.

At times, lost in all of this activity are well-child checkups and routine immunizations. Parents are quick to call the doctor at the first sign of illness, but it’s easy to lose track of appointments for a healthy child.

A half-dozen years ago, UT Medicine San Antonio family physicians at a downtown clinic realized they were not seeing many children. Those they did see often had fallen behind on scheduled vaccines or were not receiving them at all.

This was particularly troubling because the clinic – the Family Health Center at University Health System’s Robert B. Green Campus – fills an important role. Its neighborhood is home to many medically underserved people, and few nearby pediatricians accept CareLink. The Family Health Center, which does, helps meet the need.

Led by Alexandra Loffredo, M.D., UT Medicine physicians and their partners at University Health System began a concerted effort to improve vaccination rates within the community. Their work has earned national recognition and, more importantly, protected thousands of children from preventable diseases.

"People want to come back to us," said Dr. Loffredo, an associate professor in the Department of Family and Community Medicine at the UT Health Science Center. "Once we started this well-child clinic, they got such great service they just made their next appointment with us."

  Dr. Alexandra Loffredo and new-born infant at well-check-up
Alexandra Loffredo, M.D., leads efforts to help families stay current with their children’s well-child check-ups.

The first step was carving out a place within the larger Family Health Center especially for children. There are baby scales, child-sized hospital gowns and an eye chart with symbols for those who have not yet learned their letters. Child-friendly art decorates the walls. And the medical staff has set aside several times during each week to focus on their younger patients.

A group of medical assistants received special training in well-child care, including interpreting the U.S. Centers for Disease Control and Prevention’s (CDC) Immunization Schedules and administering vaccines.

Aware that many families fall behind on well-child visits and vaccinations, clinic staff found new ways to keep them on schedule. Staffers keep logs of which children are due and check to make sure they have appointments scheduled. They follow up by phone with those who do not – and, after finding that many families lack reliable phone service, they started sending bilingual appointment-reminder letters.

The clinic also fine-tuned its own record-keeping on childhood vaccinations and designated a "vaccine supply champion" to make sure needed vaccines are always in stock.

Every parent who brings a child to the Family Health Center for a well-child visit receives an English-Spanish informational booklet describing the importance of vaccines and listing ages at which they are given. As parents leave, they are given a colorful reminder card with the date their child is due back.

The clinic also has useful gifts for families of young children – each with the Family Health Center’s name and number on them. Those include diaper-wipe cases, electric outlet covers and baby spoons, and they are given at developmentally appropriate times. Children older than six months take home a new book, with the clinic maintaining a supply in English and Spanish.

Mirna Watson has been bringing her children to the clinic since moving to San Antonio about six years ago. She recently brought in two of her four children: 4-year-old Isabella and 3-year-old Juan Angel.

"I just love this place," she said. "I encourage all of my friends to come here. It’s like a big family."

The medical staff crowded around her children, expressing surprise at how much Juan Angel had grown and watching the little boy show off his muscles and ability to do pushups. Isabella was quieter at first, smiling broadly and saying little. As the appointment went on, she became inquisitive, trying to remember names and asking about people’s jobs.

She was dismayed, though, by the four shots that came at the end of her appointment. Her brother was in only for a well-child visit and braved no needles that day.

In 2011, the Family Health Center received a prestigious national award: the American Academy of Family Physicians (AAFP) Foundation Pfizer Immunization Award in the "Most Improved" category. The clinic also has earned 100 percent ratings in its last three annual site visits by the federal Vaccines for Children program, which provides vaccines at no cost for uninsured or underinsured children.

Just as important, the clinic makes life easier for busy families. "We help parents stay on top of scheduled vaccinations," said Jennifer Gonzales, the clinic’s lead medical assistant. "If we discover a child is missing one, we know that we have it in stock and can give it right away. We’re helping keep kids healthy and making sure they don’t miss school because they’re missing a required vaccination."

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Updated 12/11/14