Intervention to Reduce Pain, Anxiety of Immunization Feasible in Pediatric Practices

From Medscape Medical News
Laurie Barclay, MD

November 15, 2010 — Implementing an intervention to reduce the pain and anxiety associated with immunization delivery is feasible in pediatric practices, according to the results of a study reported online first November 15 and in the December print issue of Pediatrics.

"Many strategies have been developed to address the pain and anxiety associated with immunizations, but these often are underutilized by pediatric providers," write Neil L. Schechter, MD, from Children's Hospital Boston and Harvard Medical School in Boston, Massachusetts, and colleagues. "An educational outreach strategy known as 'academic detailing' has been effective in changing health provider practices."

This study aimed to assess the effect of a 1-hour teaching module on immunization pain reduction practices in 14 randomly selected pediatric offices at 1 and 6 months after training. Before and at 1 and 6 months after the intervention, parents were interviewed by telephone questionnaires regarding their children's recent immunization experiences. Clinicians completed a survey at baseline and at 6 months.

Thirteen practices in suburban Hartford, Connecticut, completed the study, yielding 839 telephone interviews and 92 clinician surveys. At 1 month after the intervention, there were significant improvements from baseline in parents' reports of receiving information (P = .04), using strategies to reduce pain (P < .01), learning something new (P < .01), using a ShotBlocker (Bionix [a plastic device that applies pressure at the injection site]; P < .01), using sucrose (P < .01), and having higher levels of satisfaction (P = .015). Except for satisfaction, all rates remained higher than baseline findings at 6 months (all P < .01).

Clinician surveys also documented significant increases at 6 months in the use of needles longer than 5/8 inches, sucrose, pinwheels, focused breathing, and ShotBlockers.

A 1-hour teaching session had measurable effects on the use of pain-reducing strategies at 1 and 6 months after the intervention," the study authors write. "This research supports the hypothesis that small-group teaching sessions at the site of care can be associated with changes in practice behaviors."

Limitations of this study include controversy regarding satisfaction with the clinical encounter as a multifactorial variable and the inability to determine why some interventions that were adopted initially by many practitioners remained popular while others did not.

"Importantly, no single strategy by itself has been shown to change practice behaviors uniformly, but a combination of approaches that are ongoing is far more likely to do so," the study authors conclude. "This strategy, along with others, should be considered as part of an overall plan to improve health care quality for children during their medical encounters in office settings. Finally, regarding immunizations and other procedures, children's comfort need not be sacrificed in the provision of good medical care; in fact, it should be considered an essential component of it."

The study was supported by the Mayday Fund and the Kohl Family Foundation. The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 15, 2010.

Pain Management...

I guess I thought I would have more to say about it.  And everything I do have to say, can be looked up easily online.  When I started this, I was just very emotional about the way heart surgery was performed on infants until the 1980's.  This was my way of processing.  I guess the important thing now is that we never assume the doctors are doing everything they can for our children in terms of pain management.  Be sure to talk with the doctor, understand the procedure and the pain management options, and do what you feel is best for your child.  Thanks for reading.