U.S. Physicians’ Perspective of Adult Vaccine Delivery

Abstract

Background Adults are at substantial risk for vaccine-preventable disease, but their vaccination rates remain low. Objective To assess practices for assessing vaccination status and stocking recommended vaccines, barriers to vaccination, characteristics associated with reporting financial barriers to delivering vaccines, and practices regarding vaccination by alternate vaccinators. Design Mail and Internet-based survey. Setting Survey conducted from March to June 2012. Participants General internists and family physicians throughout the United States. Measurements A financial barriers scale was created. Multivariable linear modeling for each specialty was performed to assess associations between a financial barrier score and physician and practice characteristics. Results Response rates were 79% (352 of 443) for general internists and 62% (255 of 409) for family physicians. Twenty-nine percent of general internists and 32% of family physicians reported assessing vaccination status at every visit. A minority used immunization information systems (8% and 36%, respectively). Almost all respondents reported assessing need for and stocking seasonal influenza; pneumococcal; tetanus and diphtheria; and tetanus, diphtheria, and acellular pertussis vaccines. However, fewer assessed and stocked other recommended vaccines. The most commonly reported barriers were financial. Characteristics significantly associated with reporting greater financial barriers included private practice setting, fewer than 5 providers in the practice, and, for general internists only, having more patients with Medicare Part D. The most commonly reported reasons for referring patients elsewhere included lack of insurance coverage for the vaccine (55% for general internists and 62% for family physicians) or inadequate reimbursement (36% and 41%, respectively). Patients were most often referred to pharmacies/retail stores and public health departments. Limitations Surveyed physicians may not be representative of all physicians. Conclusion Improving adult vaccination delivery will require increased use of evidence-based methods for vaccination delivery and concerted efforts to resolve financial barriers, especially for smaller practices and for general internists who see more patients with Medicare Part D. Primary Funding Source Centers for Disease Control and Prevention.

Missed opportunities for Hepatitis B vaccination among diabetic patients

“…Lack of basic knowledge and current recommendations about adult vaccination, inconsistent assessment of vaccination status and insufficient time spent on communicating the benefits of hepatitis B vaccine are doctor related barriers to vaccination. 25 Recommendations which are not supported through public funding mechanisms may decrease the uptake of the vaccine. 26 Health care system related factors such as lack of reminder-recall systems, immunization records, computerized vaccine registries and vaccine delivery systems might be other factors that contribute to low vaccine coverage rates.…”

Impact of Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccine Use in Wound Management on Health Care Costs and Pertussis Cases

“…A recent survey of U.S. physicians found that financial barriers, such as lack of reimbursement for a vaccine, low reimbursement rates for a vaccine, or coverage under Medicare Part D (which typically includes high out-of-pocket costs), were the most commonly reported reasons for low vaccination rates among adults. 12 Because of low vaccination rates, ACIP recommends physicians vaccinate persons aged 65+ years with either Tdap vaccine they have available so as not to "miss an opportunity to vaccinate." 7 Although the Affordable Care Act mandated that private health plans cover all vaccines recommended by ACIP without requiring a copayment, eliminating the financial barrier for individuals with private insurance, this law does not impact Medicare coverage policies.…”

“…Additionally, Tdap coverage rates among adults may have been historically low as a result of lack of insurance coverage for the vaccine or low reimbursement rates prior to implementation of the Affordable Care Act. 12 Individuals present to the health system for wound management with an estimated annual incidence rate between 0.028 per 100,000 (aged 65+ years) and 0.053 per 100,000 (aged 15-24 years). 13 Thus, the CDC recommendation for the use of Tdap in routine wound management could help to increase the coverage rates for pertussis revaccination in the adolescent and adult populations in the United States.…”

Engagement in a Diverse Urban Community to Describe Community Residents’ Perceptions of Pharmacists as Immunizers

“…Literature supports that primary physicians are commonly discussing issues of preventative medicine with their patients due to better awareness of vaccine needs, and enhanced insurance coverage of preventative health services. 21,22 These points suggest pharmacy personnel modify messages communicated about vaccines and communication strategies to improve use of pharmacy-based immunization services. Communication styles that resemble patient and physician interactions may be more familiar to these patients and adequately address concerns about vaccines.…”