Pneumococcal Vaccination in General Internal Medicine Practice: Current Practice and Future Possibilities

Abstract

BACKGROUND: Pneumococcal vaccine (PPV) is recommended for adults ≥65 years and those with chronic illness, but there are potential advantages of universal vaccination of adults age 50-64 years. OBJECTIVE:To assess reported (1) recommendations and administration practices of general internists for PPV, (2) barriers to vaccination, and (3) willingness to expand vaccination to all adults ≥50 years.METHODS: National survey of general internists representative of the American College of Physicians. RESULTS:Response rate was 74% (N=326). Although 99% reported giving PPV, less than 20% used a computerized database to identify eligible patients by age or diagnoses and only 6% recalled patients. Major barriers included acute problems taking precedence over preventive care (39%), difficulty determining vaccination history (30%), not thinking of it/not a priority (20%), and inadequate reimbursement for vaccine (19%). If ACIP expanded recommendations, 60% would definitely and 37% would probably institute this change.CONCLUSIONS: Most general internists reported giving PPV, but delivery was hindered by competing demands, lack of systems to identify patients needing vaccination, and reimbursement issues. Barriers might be decreased by a policy of universal vaccination of adults ≥50 years, and the majority of physicians reported they would follow such a recommendation if it were made.

Outpatient-Based Pneumococcal Vaccine Campaign and Survey of Perceptions about Pneumococcal Vaccination in Patients and Doctors

“…Many barriers to achieving high pneumococcal vaccination levels have previously been identified, including missed opportunities, competing demand, pitfalls in the vaccine delivery system, fears regarding adverse effects, and lack of awareness regarding the seriousness of IPD 10,15. In the present study, we evaluated encouraging factors and barriers of pneumococcal vaccination in Korea, a country with low vaccine coverage rates.…”

Predictors of Tetanus–Diphtheria– Acellular Pertussis Vaccination Among Adults Receiving Tetanus Vaccine in the United States

“…11,22,23 Providers may also miss opportunities to vaccinate because of competing demands, which could explain why respondents in this study were not more likely to receive pertussis vaccination with 10 or more yearly office visits. 21,24 In the setting of complex office visits, there may be little time to fully explain the benefit of pertussis vaccination and its rationale over routine tetanus vaccine.…”

“…The potential predictor variables were chosen based on studies suggesting that barriers to vaccination are often related to sociodemographics, utilization of health care services, health status, and an individuals' preventive behavior. [13][14][15][16] Sociodemographic variables included age (18)(19)(20)(21)(22)(23)(24), and 50-64 years), race-ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, other), gender, language (English, non-English), US census region, dependent children <18 years old (yes/ no), marital status (married, not married), education level (high school or less vs more than high school), employment status (employed vs unemployed), and total family income level (<$35 000, $35 000 up to $74 999, $75 000 up to $99 999, and ≥$100 000).…”

National Survey of Primary Care Physicians Regarding Herpes Zoster and the Herpes Zoster Vaccine

“…In a prior investigation conducted in this network, attitudes of sentinel GIM physicians regarding polysaccharide pneumococcal vaccine were found to be generally comparable to the attitudes of GIM physicians randomly sampled from the American Medical Association (AMA) [10]. For the current survey, the first conducted in the sentinel FM network, attitudes of sentinel FM physicians were compared with those of FM physicians randomly sampled from the AMA on 6 key questions selected before the conduct of the survey.…”