According to the Centers for Disease Control and Prevention, child vaccinations across the United States decreased by more than 21% between January and April of last year. With public health response measures to mitigate the ongoing pandemic centered on social distancing and quarantine policies, including shelter-in-place and stay-at-home orders, many parents simply did not take their children in for their vaccinations.
Dr. Renata Lukezic is not only concerned about this trend, she's also doing something about it.
Lukezic, a board certified pediatrician assigned to Navy Medical Readiness and Training Unit Everett in Washington, voluntarily took over as the immunization provider for the clinic due to her clinical expertise, vested interest in providing safe services and to continue her patient advocacy efforts.
"Immunizations are a cornerstone of pediatrics. We want to prevent disease, so it was a natural transition for me to assume this role," explained Lukezic. "In my career, I have thankfully seen several diseases go away because of the implementation of vaccines. That is really satisfying to know that such a big impact can be made in such a short period of time. Vaccines do work and are very effective."
According to Navy Lt. Cmdr. Andrew Rutledge, NMRTU Everett officer in charge, Lukesic is frequently sought out for guidance in immunizations scheduling. Perhaps more importantly, she has strived to provide working solutions in multiple patient safety reports to improve immunizations protocol. First, she was instrumental in reviewing and improving the provider vaccine ordering form which helped to reduce any potential administrative glitch related to improper vaccine ordering. She then helped to provide training and process solutions for increased staff awareness to ensure vaccines were given in the appropriate time frames.
Providing immunizations is but one example of Lukezic extending her patient-centered care beyond just giving a shot. She takes the time during the vaccination process to address the reasons why it's important for the child, explaining not just to the parent, but also to the youngster.
Lukezic strongly encourages that children are in need of health literacy skills early in life. Helping, educating and encouraging them can help build their understanding and knowledge of their health and wellness.
"I like to spend my patient encounters speaking directly to the patient as much as possible. Most school age children can provide an excellent medical history," Lukezic said. "A lot of parents are a little taken aback by this, especially when meeting me for the first time. But I want the child to be engaged and to feel like they have a lot of control. Adolescent patients should be able to provide the entire history."
The ongoing pandemic has also meant not only finding new ways to reach patients - both parent and child - but also expand the clinic capabilities in doing so. Lukezic has done just that.
"At NMRTU Everett, we were able to add telehealth in two ways. First we were able to engage several unique subspecialists through Madigan Army Medical Center directly to our patients without needing to have the patient travel," she continued. "And then we also started using telehealth to address some chronic medical needs especially for our adolescent patients. COVID-19 certainly has increased the need for telehealth even further."
"Parents are very pleased with telehealth services," continued Lukezic. "They can stay in the comfort of their own home. They do not have to worry about child care for siblings. They can even get medication delivered to their front door, if needed. Safety needs to always be the first priority and not all patient concerns can be addressed with telehealth but for many concerns, this is a great option."
Lukezic also coordinated expansion of telehealth services for pediatric psychiatry to support developmentally delayed youth in the clinic's area - serving a catchment area approximately 30 miles north of Seattle, by partnering with Tripler Army Medical Center in Hawaii.
"At my previous duty location, I was actively involved in implementing primary and subspecialty telehealth services in a remote rural location. I was able to see firsthand that in the right circumstances, it was a very convenient and safe way to deliver medical care," related Lukezic.
Recognizing a growing tendency of obesity and increased comorbidities among children and adolescents also prompted Lukezic to head a project to evaluate effectiveness of interventions to determine the best courses of treatment to ensure a healthy and ready family population.
She's held classes for youth in her support of Naval Station Everett's Fleet and Family Support Center's Child and Youth Program (CYP) Inclusion Action Team (IAT). She addressed such topics as obesity, provided pregnancy information, and focused on increasing the health literacy for parents on common childhood illnesses, diet and nutritional needs, as well as normal child development.
As part of the CYP IAT, Lukezic regularly met with Naval Station Everett Child Development Center and Child Development Home leadership to assess the needs of high risk children assigned to the local area to ensure necessities were being met.
"Families really appreciate having access to a pediatrician, as pediatricians are specifically trained to take care of children from the newborn period through young adulthood. It is my opinion that we really need to empower the entire family to meet their health goals. I know there are multiple definitions of health but the one that speaks the most to me is, "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity," stated Lukezic.
Whether in a clinical setting, via live telehealth stream, or even an available classroom, Dr. Lukezic is at home doing what she enjoys in caring for those in need.
"There are two aspects of my job that I just love," explained Lukezic. "The first is seeing my families succeed in their health goals. Whether it is a mother successfully breastfeeding after a challenging neonatal intensive care unit stay or a school age child controlling their asthma and now exercising without limits. I really enjoy the personal connections with my families as we work together to meet their needs."
"Second, I really like working with the corpsmen. Their curiosity and vigor for learning new things is so contagious. I love to teach and encourage them in their roles. Many are already working on advanced degrees and it feels great to empower our future health care providers."
There might be just one drawback to her lengthy work schedule for the dedicated doctor; not enough hours in the day.
"Having enough time to spend with patients is always a challenge. This challenge calls on me to stay creative and think of other ways to meet this need. Telehealth services was one answer to this challenge but I know there are other courses of action to consider as well. I know I have to stay creative and I know I have to do this with true purpose and presence," Lukezic stressed.