This article is more than 5 years old. Information may no longer be current.
PCPs cite financial barriers to stocking most adult vaccines
A survey of general internists and family physicians indicated that financial concerns were the most common barrier to assessing need for and stocking recommended adult vaccines.
According to the report in Annals of Internal Medicine, nearly all respondents stocked influenza, pneumococcal, tetanus-diphtheria and tetanus-diphtheria-acellular pertussis vaccines, but they were less likely to stock hepatitis vaccines, catch-up vaccines and zoster vaccine.
The study included 352 general internists and 255 family physicians who responded to the survey, which was conducted from March to June 2012. The physicians answered questions on their practices regarding assessment of vaccination status for adult vaccines and stocking 11 of the adult vaccines routinely recommended in 2012. They also were asked about referring practices to alternate vaccine suppliers when they did not stock a vaccine.
Nearly all physicians assessed patients’ vaccination status at annual visits or initial visits, but only 29% of general internists and 32% of family physicians reported assessing vaccination status at every visit. Most physicians did so by checking the medical records. Most physicians also asked patients about vaccination status, but very few relied on patient-supplied information.
Most assessed the need for influenza, pneumococcal, Td, Tdap and zoster vaccines. Family physicians were more likely to assess the need for other recommended vaccines, including hepatitis A, hepatitis B, measles-mumps-rubella, HPV, meningococcal and varicella. Family physicians were more likely to stock hepatitis B and catch-up vaccines. Many physicians, both family physicians and general internists, did not stock the zoster vaccine.
The most common alternate sites that patients were referred to for a vaccine the physician did not have in stock was a pharmacy/retail store and the public health department. The most common reasons for referring patients elsewhere for a vaccine were insurance not covering the vaccine or inadequate insurance reimbursement.
“Although primary care physicians appear motivated to ensure that patients are up to date on vaccinations, many barriers exist,” the researchers wrote. “Implementation of system changes, including adopting practices that improve communication between primary care physicians and alternate vaccinators, more widespread use of effective tools and removing policy-related barriers, could improve adult vaccination in the United States.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to Top
Adult vaccination is a major public health issue. Of the 30,000 people that die each year from vaccine preventable diseases, 97% are adults. The most recent National Health Interview Survey (NHIS) shows "we" are failing our patients. Only 20% of high-risk patients aged 19 to 64 and only 59.9% of those aged 65 and older have received the pneumococcal vaccination. Only 20.1% of adults aged 60 and older have received shingles vaccine. Only 15.6% of adults have received a Tdap booster. Only 34.5% of young women aged 19 to 26 have received at least one dose of the HPV vaccine.
Why is there a disconnect between need and delivery? In this study, Hurley et al looked at adult vaccine delivery from a physician's prospective. Most (97%) of the physicians surveyed assess vaccine status annually. Standing orders for needed vaccines could help fill in coverage gaps. Most practices surveyed don't stock all adult vaccines, especially the more expensive ones. The primary barrier focuses on financial aspects of vaccine delivery: inadequate reimbursement and lack of insurance coverage. In my experience, the minimum 10-dose purchase requirement for many of the more expensive vaccines is a definite financial barrier for many small practices. Although the Affordable Care Act provision of no co-pay coverage of ACIP-recommended vaccines within one year of the committee’s recommendation should improve coverage, speed bumps in ACA implementation may weaken expected advances in adult vaccine coverage.