Title: Medical Dental Integration for Vaccinations and Well Child Checks: A Targeted Intervention to Increase Rates of Tdap, MCV4, and HPV9 vaccines and Well Child Checks for children ages 9-17.

Abstract

Background: Children older than 9 years of age typically see the dentist more often than they do their primary care provider.¹ This highlights an opportunity to collaborate with dentistry to promote timely vaccinations and well child checks (WCC). This study had two aims; 1) to increase vaccination rates of the Tdap, MCV4 and HPV9 vaccines in patients aged 9-17 through vaccination at pediatric dental visits, and 2) to assess if WCC and vaccination completion could be increased through reminders during dental visits and assisted scheduling for overdue patients.

Learning Outcomes: At the conclusion of the presentation attendees should be able to: 1) recognize the importance of encouraging preventative health measures in dental care visits, including providing vaccinations, and 2) identify methods to help them apply a similar framework in their clinics.

Methods: Established patients ages 9-17 overdue for Tdap, MCV4, HPV9 or WCCs from three dental clinics with visits from 5/24/21-8/27/21 (N=442) were identified and offered vaccines as well as the opportunity to schedule WCCs during their dental visits. Dental clinics in the study were co-located with medical clinics and patients received vaccinations from medical assistants in medical clinic or scheduled follow up care. Chart review was conducted to determine if vaccines were administered. Collated data on patients who still needed vaccines or WCC were sent clerical staff for scheduling. Thirty days after visit, chart review was conducted to determine if vaccines and WCC had been completed.

Results: Across all three dental clinics, 10.1% (N=45) received their overdue vaccines during their dental visits. Of the three clinics, the Montbello Clinic was the most successful, vaccinating 22.7% (N=26) of overdue patients. Across all clinics, within 30 days of a dental visit 31% (N=103) of patients who were overdue for vaccines at their visit received their vaccinations and 34% (N=59) of patients completed their WCC. Compared to those who no showed or cancelled, patients who saw the dentist and were counselled on vaccines were 15% more likely to complete their vaccines and 19% more likely to complete their WCC within 30 days.

Conclusion: It is evident that there is a significant benefit to integrating the medical and dental disciplines at the routine dental visit. This intervention identifies and vaccinates children who otherwise may not have presented for routine medical care. Patients were receptive to receiving routine vaccines in the dental setting. The dental office appears to be an effective and appropriate place to offer reminders regarding vaccines and preventative health measures to patients and their parents. This highlights that dentists, dental assistants, and auxiliary team members play a powerful role in promoting and improving WCC compliance and vaccination rates.

Implications: Adolescent primary care and dental providers should work together collaboratively to increase both preventive health measures and vaccines among this population. Future work should look at expanding the vaccines to younger children, adults, and influenza vaccination.

¹David Okuji et al. Opportunities for Age-Specific Interprofessional Collaboration Between Physicians and Dentists in Pediatric Patients. Pediatr Dent May 15 2020 ;42(3):203-207.