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PCPs struggle to follow adult pneumococcal vaccine guidelines

There is a “disconnect” between “perceived knowledge and clarity” of the current Advisory Committee on Immunization Practices pneumococcal vaccine recommendations for at-risk adults among primary care physicians, according to findings recently published in the Journal of the American Board of Family Medicine.

“Because physician recommendation is so important to patients’ receipt of vaccines, we sought to describe the current practice, knowledge, attitudes, and beliefs of primary care physicians,” Laura P. Hurley, MD, MPH, of the Adult and Child Consortium for Health Outcomes Research and Delivery Science at the University of Colorado, and colleagues wrote.

Researchers analyzed survey responses from 617 primary care physicians across the U.S. related to the Advisory Committee on Immunization Practices’ (ACIP) recommendations for the pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccines for at-risk adults older than 19 years and adults older than 65 years.

Hurley and colleagues found that familiarity with the recommendations among PCPs varied, with only 21% knowing the recommended interval between PCV13 and PPSV23 in at-risk patients aged younger than 65 years, and 83% knowing the PCV13 recommendation for adults 65 and older. More than 95% of respondents reported regularly evaluating adults’ vaccination status and recommending both vaccines. Thirty-eight percent of PCPs said the recommendations were “somewhat clear” and half said the recommendations were “clear.”

In addition, 20% of the respondents said problems in obtaining vaccination history, inadequate reimbursement, lack of insurance coverage and the upfront cost of buying PCV13 were “major barriers” to administering these vaccines. Further, up to 58% of respondents answered questions wrong, despite one option being they wished to look the information up prior to responding. More than 90% of respondents indicated they used electronic health records, but only about 33% said they had an electronic method to determine which high-risk patients needed either pneumococcal vaccine.

“The practices reported by primary care physicians with regard to stocking and recommending pneumococcal vaccines suggest a positive outlook for implementation of the ACIP recommendations. However, realizing optimal implementation will require ensuring coverage for these vaccines, making physicians aware of this coverage, and addressing knowledge gaps regarding these recommendations,” Hurley and colleagues wrote.

“Our data support harnessing EHR capability to create accurate [clinical decision support systems] for these complex recommendations that would actively prompt physicians to accurately apply ACIP pneumococcal recommendations, as opposed to looking up information they think they know,” they added. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.