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Wang Z, Jamal A, Wang R, Dan S, Kappagoda S, Kim G, Palaniappan L, Long J, Singh J, Srinivasan M. Disparities and Trends in Routine Adult Vaccination Rates Among Disaggregated Asian American Subgroups, National Health Interview Survey 2006-2018. AJPM FOCUS 2023; 2:100044. [PMID: 37789943 PMCID: PMC10546520 DOI: 10.1016/j.focus.2022.100044] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Vaccination rates may be improved through culturally tailored messages, but little is known about them among disaggregated Asian American subgroups. We assessed the vaccination rates for key vaccines among these subgroups. Methods Using the National Health Interview Survey, we analyzed recent vaccination rates (2015-2018, n=188,250) and trends (2006-2018) among Asians (Chinese [n=3,165], Asian Indian [n=3,525], Filipino [n=3,656], other Asian [n=5,819]) and non-Hispanic White adults (n=172,085) for 6 vaccines (the human papillomavirus, hepatitis B, pneumococcal, influenza, tetanus-diphtheria [tetanus], and shingles vaccines). We controlled demographic, socioeconomic, and health-related variables in multivariable logistic regression and predicted marginal modeling analyses. We also computed vaccination rates among Asian American subgroups on the 2015-2018 National Health Interview Survey data stratified by foreign-born and U.S.-born status. We used Joinpoint regression to analyze trends in vaccination rates. All analyses were conducted in 2021 and 2022. Results Among Asians, shingles (29.2%; 95% CI=26.6, 32.0), tetanus (53.7%; 95% CI=51.8, 55.6), and pneumococcal (53.8%; 95% CI=50.1, 57.4) vaccination rates were lower than among non-Hispanic Whites. Influenza (47.9%; 95% CI=46.2, 49.6) and hepatitis B (40.5%; 95% CI=39.0, 42.7) vaccination rates were similar or higher than among non-Hispanic Whites (48.4%; 95% CI=47.9, 48.9 and 30.7%; 95% CI=30.1, 31.3, respectively). Among Asians, we found substantial variations in vaccination rates and trends. For example, Asian Indian women had lower human papillomavirus vaccination rates (12.9%; 95% CI=9.1, 18.0) than all other Asian subgroups (Chinese: 37.9%; 95% CI=31.1, 45.2; Filipinos: 38.7%; 95% CI=29.9, 48.3; other Asians: 30.4%; 95% CI=24.8, 36.7) and non-Hispanic Whites (36.1%; 95% CI=34.8, 37.5). Being male, having lower educational attainment and income, having no health insurance or covered by public health insurance only, and lower frequency of doctor visits were generally associated with lower vaccine uptakes. Foreign-born Asian aggregate had lower vaccination rates than U.S.-born Asian aggregate for all vaccines except for influenza. We also found subgroup-level differences in vaccination rates between foreign-born and U.S.-born Asians. We found that (1) foreign-born Chinese, Asian Indians, and other Asians had lower human papillomavirus and hepatitis B vaccination rates; (2) foreign-born Chinese and Filipinos had lower pneumococcal vaccination rates; (3) foreign-born Chinese and Asian Indians had lower influenza vaccination rates; and (4) all foreign-born Asian subgroups had lower tetanus vaccination rates. Conclusions Vaccination rates and trends differed among Asian American subgroups. Culturally tailored messaging and interventions may improve vaccine uptakes.
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Affiliation(s)
- Ziqing Wang
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Statistics and Data Science, Cornell University, Ithaca, New York
| | - Armaan Jamal
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan Wang
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of BioSciences, Rice University, Houston, Texas
- Department of Computer Science, Rice University, Houston, Texas
| | - Shozen Dan
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Mathematics, Imperial College London, London, United Kingdom
- Department of Statistics, Imperial College London, London, United Kingdom
| | - Shanthi Kappagoda
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Infectious Diseases & Geographic Medicine, Stanford University School of Medicine, Stanford, California
| | - Gloria Kim
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jaiveer Singh
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Molecular Biochemistry and Biophysics, Yale University, New Heaven, Connecticut
| | - Malathi Srinivasan
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Prieto-Campo Á, García-Álvarez RM, López-Durán A, Roque F, Herdeiro MT, Figueiras A, Zapata-Cachafeiro M. Understanding Primary Care Physician Vaccination Behaviour: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13872. [PMID: 36360750 PMCID: PMC9654811 DOI: 10.3390/ijerph192113872] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Vaccine hesitancy decreases adult vaccination coverage and has been recognized by WHO as a major health threat. Primary care physicians (PCP) play a key role in vaccination by giving vaccine counselling to their patients. The aim of this systematic review is to identify the knowledge, beliefs, attitudes and barriers (KBAB) associated with own vaccination and patient recommendation in primary care physicians. METHODS MEDLINE/PubMed, EMBASE and Cochrane Library databases were used to search and identify relevant studies based on their title and abstract. In the next step, the full text of each previously selected article was read for eligibility. Articles were selected by two independent reviewers and data extraction was performed using tables. The following information was extracted: methodological characteristics, demographic factors, professional characteristics, and intrinsic or extrinsic factors influencing vaccination or recommendation. RESULTS Our search yielded 41 eligible papers, data-sources, previous practices, belief in the effectiveness or safety of the vaccine, perceived risk, and trust in health authorities were all shown to be related to own vaccination and patient recommendation. CONCLUSION Internet is the main source of information for PCP related to vaccine hesitancy. It is therefore essential to increase the presence and access to pro-vaccination content in this area. In addition, involving PCP in the establishment of vaccination recommendations could improve their credibility in the institutions. On the other hand, training in communication skills and establishing reminder systems could reflect higher vaccination coverage among their patients.
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Affiliation(s)
- Ángela Prieto-Campo
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786 Santiago de Compostela, Spain
| | - Rosa María García-Álvarez
- Department of Preventive Medicine and Public Health, Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Ana López-Durán
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15786 Santiago de Compostela, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Avenida Dr. Francisco Sá Carneiro, No. 50, 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
- Escola Superior de Saúde, Instituto Politécnico da Guarda Rua da Cadeia, 6300-035 Guarda, Portugal
| | - Maria Teresa Herdeiro
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786 Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15786 Santiago de Compostela, Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786 Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15786 Santiago de Compostela, Spain
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Crosson FJ. Medicare Coverage of Vaccines-A Work in Progress. JAMA Intern Med 2022; 182:585-586. [PMID: 35377405 DOI: 10.1001/jamainternmed.2022.0624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Francis J Crosson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Kolobova I, Nyaku MK, Karakusevic A, Bridge D, Fotheringham I, O'Brien M. Vaccine uptake and barriers to vaccination among at-risk adult populations in the US. Hum Vaccin Immunother 2022; 18:2055422. [PMID: 35536017 PMCID: PMC9248946 DOI: 10.1080/21645515.2022.2055422] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To reduce morbidity and mortality associated with vaccine-preventable diseases (VPD), it is imperative that vaccination programs are implemented and prioritized throughout all stages of life across all populations. This study aimed to determine vaccine uptake and barriers to vaccination against VPDs among at-risk adult populations in the United States. We conducted a systematic literature review for articles published between January 2010 and June 2020 and identified 153 publications. The review identified 17 at-risk populations. Vaccine uptake was suboptimal among many populations, with factors including age, gender, and disease severity, associated with uptake. This review identified several barriers that impact vaccine uptake among at-risk populations, with concerns over safety, vaccine costs, lack of insurance, and lack of provider recommendation commonly reported across populations. Embracing a national life-course immunization framework that integrates developing policies, guidelines, and education would be a step to addressing these barriers.
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Affiliation(s)
- Irina Kolobova
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Mawuli Kwame Nyaku
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Megan O'Brien
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Yawn BP, Loskutova NY, Merrill DD, Martinez S, Callen E, Cotton J, Carroll JK, Williams D. Health Care Professionals' Herpes Zoster Awareness and Vaccine Recommendations for Patients with COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:562-575. [PMID: 36199223 PMCID: PMC9718579 DOI: 10.15326/jcopdf.2022.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives The objective of this study was to assess health care professionals' (HCPs) knowledge of an increased herpes zoster (HZ) risk and burden for patients with chronic obstructive pulmonary disease (COPD), HCPs' familiarity with the Advisory Committee on Immunization Practices' (ACIP) HZ vaccine recommendations, and the HCPs' current adult vaccine practices. Another objective was to evaluate the impact of a short educational video on knowledge and future vaccine intent. Participants and Methods An online survey of family physicians (FPs), pulmonologists, nurse practitioners (NPs), and physician assistants (PAs) querying demographics, awareness of ACIP HZ vaccine recommendations, and HZ burdens and risks in patients with COPD and their current recommendations for HZ, influenza, and pneumococcal vaccines was conducted. For those not strongly recommending HZ vaccines concordant with ACIP recommendations, a 5-minute educational video was presented, and post video questions assessed future intended HZ vaccine recommendations. Results Among 1020 HCP responders, awareness and ACIP concordant HZ vaccine recommendations ranged from 59.0% to 95.2% across HCPs. Lowest recommendation rates were consistently reported by pulmonologists for the 2-dose HZ vaccine beginning at age 50; for the 2-dose vaccine use in those with prior 1-dose HZ vaccinations, and for those with prior HZ. Among all HCPs, HZ vaccine recommendations were lower than for pneumococcal and influenza vaccines. After viewing the educational video, reported vaccine recommendation intent increased significantly in all groups of HCPs, as did awareness of increased HZ risk among patients with COPD. Conclusions Significant educational opportunities exist for HCPs related to HZ and its vaccine prevention among patients with COPD which may be responsive to brief, targeted interventions.
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Affiliation(s)
- Barbara P. Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, Minnesota, United States,COPD Foundation, Miami, Florida, United States,*Affiliation at the time the study was conducted
| | - Natalia Y. Loskutova
- American Academy of Family Physicians National Research Network, Leawood, Kansas, United States,*Affiliation at the time the study was conducted
| | | | | | - Elisabeth Callen
- American Academy of Family Physicians National Research Network, Leawood, Kansas, United States
| | | | - Jennifer K. Carroll
- American Academy of Family Physicians National Research Network, Leawood, Kansas, United States,Department of Family Medicine, University of Colorado, Aurora, Colorado, United States
| | - Dennis Williams
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, United States
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Racial/Ethnic and Socioeconomic Disparities in Adult Vaccination Coverage. Am J Prev Med 2021; 61:465-473. [PMID: 34334289 DOI: 10.1016/j.amepre.2021.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Adults from racial and ethnic minorities and low-income groups are disproportionately affected by vaccine-preventable diseases. The objective of this study is to examine the trends in adult vaccination coverage in the U.S. by race/ethnicity and SES from 2010 to 2019. METHODS Temporal trends in influenza; pneumococcal; herpes zoster; and tetanus, diphtheria, and acellular pertussis vaccination coverage were examined by race/ethnicity and SES in 2020 using the National Health Interview Surveys from 2010 to 2019. RESULTS Influenza vaccination coverage differed by race/ethnicity among adults aged ≥65 years (61.4% for Black, 63.9% for Hispanic, 71.9% for Asian, and 72.4% for White adults). Race/ethnicity, household income, education level, and health insurance type were significantly associated with receipt of influenza; pneumococcal; tetanus, diphtheria, and acellular pertussis; and zoster vaccinations among adults aged ≥65 years in a multivariable-adjusted regression model. Socioeconomic differences in influenza vaccine uptake narrowed among adults aged 18-64 years from 2010 to 2019. By contrast, racial/ethnic and socioeconomic differences in vaccine uptake persisted from 2010 to 2019 among adults aged ≥65 years. CONCLUSIONS Racial and ethnic disparities in vaccine uptake persisted over the last decade. Socioeconomic disparities in influenza vaccine coverage narrowed among adults aged 18-64 years; however, disparities persisted among adults aged ≥65 years. Efforts are urgently needed to achieve equity in immunization rates.
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Kempe A, Lindley MC, O'Leary ST, Crane LA, Cataldi JR, Brtnikova M, Beaty BL, Matlock DD, Gorman C, Hurley LP. Shared Clinical Decision-Making Recommendations for Adult Immunization: What Do Physicians Think? J Gen Intern Med 2021; 36:2283-2291. [PMID: 33528783 PMCID: PMC8342675 DOI: 10.1007/s11606-020-06456-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND In 2019, the Advisory Committee on Immunization Practices (ACIP) incorporated the terminology "shared clinical decision-making" (SDM) into recommendations for two adult vaccines. OBJECTIVE To assess among general internal medicine physicians (GIMs) and family physicians (FPs) nationally (1) attitudes about and experience with ACIP SDM recommendations, (2) knowledge of insurance reimbursement for vaccines with SDM recommendations, (3) how SDM recommendations are incorporated into vaccine forecasting software, and (4) physician and practice characteristics associated with not knowing how to implement SDM. DESIGN Survey conducted in October 2019-January 2020 by mail or internet based on preference. PARTICIPANTS Networks of GIMs and FPs recruited from American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) who practice ≥ 50% in primary care. Post-stratification quota sampling performed to ensure networks similar to ACP and AAFP memberships. MAIN MEASURES Responses on 4-point Likert scales (attitudes/experiences), true/false options (knowledge), and categorical response options (forecasting). Multivariable modeling with outcome of "not knowing how to implement SDM" conducted. KEY RESULTS Response rate was 64% (617/968). Most physicians strongly/somewhat agreed SDM requires more time than routine recommendations (90%FP; 95%GIM, p = 0.02) and that they need specific talking points to guide SDM discussions (79%FP; 84%GIM, p = NS). There was both support for SDM recommendations for certain vaccines (81%FP; 75%GIM, p = 0.06) and agreement that SDM creates confusion (64%FP; 76%GIM, p = 0.001). Only 41%FP and 43%GIM knew vaccines recommended for SDM would be covered by most health insurance. Overall, 38% reported SDM recommendations are displayed as "recommended" and 23% that they did not result in any recommendation in forecasting software. In adjusted multivariable models, GIMs [risk ratio 1.44 (1.15-1.81)] and females [1.28 (1.02-1.60)] were significantly associated with not knowing how to implement SDM recommendations CONCLUSIONS: To be successful in a primary care setting, SDM for adult vaccination will require thoughtful implementation with decision-making support for patients and physicians.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lori A Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Department of Community and Behavioral Health, Colorado School of Public Health, Denver, CO, USA
| | - Jessica R Cataldi
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Daniel D Matlock
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Division of Geriatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carol Gorman
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Laura P Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Division of General Internal Medicine, Denver Health, Denver, CO, USA
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Kasting ML, Head KJ, DeMaria AL, Neuman MK, Russell AL, Robertson SE, Rouse CE, Zimet GD. A National Survey of Obstetrician/Gynecologists' Knowledge, Attitudes, and Beliefs Regarding Adult Human Papillomavirus Vaccination. J Womens Health (Larchmt) 2021; 30:1476-1484. [PMID: 33428518 DOI: 10.1089/jwh.2020.8727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Many women see an obstetrician/gynecologist (OB/GYN) annually and receive their primary care from an OB/GYN. Understanding OB/GYNs' human papillomavirus (HPV) vaccination practices, including knowledge of and barriers to vaccination, is essential to design effective interventions to increase vaccination. This study evaluated OB/GYN knowledge, attitudes, and beliefs regarding vaccinating both younger (18-26 years) and mid-adult (27-45 years) women. Materials and Methods: Data were collected from OB/GYN providers in October 2019 through a nationwide web-based survey. Items included the following: HPV-related vaccination practices, recommendation strength, knowledge (seven items), benefits (four items), and barriers (eight items). Results: The sample (n = 224) was majority were White (69%), men (56%), and practice in suburban clinics (55%). Most (84%) reported they usually or always recommend HPV vaccine to eligible patients, but estimated only about half (51%) of other OB/GYNs did the same. Recommendation strength varied by patient age with 84% strongly recommending it to patients ≤18 years, compared with 79% and 25% strongly recommending to younger and mid-adult patients, respectively (p < 0.01). Participants reported lower benefits (p = 0.007) and higher barriers (p < 0.001) for 27- to 45-year-old patients compared with younger patients. Cost was the most frequently reported barrier, regardless of patient age. Overall knowledge was high (m = 5.2/7) but 33% of participants did not know the vaccine was safe while breastfeeding. Conclusions: Although providers reported strongly and consistently recommending the HPV vaccination to their adult patients, there were gaps in knowledge and attitudinal barriers that need to be addressed. Provider performance feedback may be important in improving HPV vaccination awareness among providers.
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Affiliation(s)
- Monica L Kasting
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA.,Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Monica K Neuman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Allissa L Russell
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Sharon E Robertson
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Caroline E Rouse
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Dempsey AF, Pyrzanowski J, Campbell J, Brewer S, Sevick C, O’Leary ST. Cost and reimbursement of providing routine vaccines in outpatient obstetrician/gynecologist settings. Am J Obstet Gynecol 2020; 223:562.e1-562.e8. [PMID: 32179023 DOI: 10.1016/j.ajog.2020.02.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the costs and reimbursement associated with running a vaccine program in 5 obstetrics/gynecology practices in Colorado that had participated in a 3-year randomized, controlled trial focused on increasing vaccination in this setting. MATERIALS AND METHODS This was a secondary analysis on costs from 5 clinics participating in a cluster-randomized controlled trial that assessed the effectiveness of a multimodal intervention to improve vaccination rates in outpatient obstetrics/gynecology clinics in central Colorado. The intervention included designation of an immunization champion within the practice, purchasing recommended vaccines for the practice, guidance on storage and management, implementing practices for routine identification of eligible patients for vaccination using the medical record, implementation of standing orders for vaccination, and vaccine administration to patients. Data on costs were gathered from office invoices, claims data, surveys and in-person observations during the course of the trial. These data incorporated supply and personnel costs for administering vaccines to individual patients that were derived from a combination of time-motion studies of staff and provider clinical activity, and practice reports, as well as costs related to maintaining the vaccination program at the practice level, which were derived from practice reports and invoices. Cost data for personnel time during visits in which vaccination was assessed and/or discussed, but no vaccine was given to the patient were also included in the main analysis. Data on practice revenue were derived from practice reimbursement records. All costs were described in 2014 dollars. The primary analysis was the proportion of costs for the program that were reimbursed, aggregated over all years of the study and combining all vaccines and practices, separated by obstetrics vs gynecology patients. RESULTS Collectively the 5 clinics served >40,000 patient during the study period and served a population that was 16% Medicaid. Over the 3-year observation period, there were 6573 vaccination claims made collectively by the practices (4657 for obstetric patients, 1916 for gynecology patients). The most expensive component of the program was the material costs of the vaccines themselves, which ranged from a low of $9.67 for influenza vaccines, to a high of $141.40 for human papillomavirus vaccine. Staff costs for assessing and delivering vaccines during patient visits were minimal ($0.09-$1.24 per patient visit depending on the practice and whether an obstetrics or gynecology visit was being assessed) compared with staff costs for maintaining the program at a practice level (ie, assessing inventory, ordering and stocking vaccines; $0.89-$105.89 per vaccine dose given). When assessing all costs compared with all reimbursement, we found that vaccines for obstetrics patients were reimbursed at 159% of the costs over the study period, and for gynecology patients at 97% of the costs. Overall, the vaccination program was financially favorable across the practices, averaging 125% reimbursement of costs across the three study years. CONCLUSION Providing routine vaccines to patients in the ambulatory obstetrics/gynecology setting is generally not financially prohibitive for practices, and may even be financially beneficial, though there is variability between practices that can affect the overall reimbursement margin.
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Martinez ML, Coles S. Addressing Immunization Health Disparities. Prim Care 2020; 47:483-495. [DOI: 10.1016/j.pop.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bowers BL, Rowe JM, Stafford RA. Using an Algorithm to Assess Vaccination Among Patients Who Attended a Pharmacy Student–Driven Statewide Free Health Screening. J Pharm Pract 2020; 33:425-432. [DOI: 10.1177/0897190018815367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background National vaccination rates remain below goals. Given the geographic availability of community pharmacies, pharmacists are uniquely positioned to provide immunizations. However, many pharmacists may not be proactively recommending vaccinations to patients. Objective The objective of this project was to assess recommendation acceptance rates among patients who attended a pharmacy student–driven statewide free health screening. Methods A brief algorithm addressing 4 routine adult vaccinations was created for use by student pharmacists to initiate conversations regarding potentially indicated vaccines with patients. This algorithm was employed at statewide screenings in 2014 and 2015 with expert users available for further discussion. Follow-up to determine recommendation acceptance and identify barriers to immunization occurred 3 to 12 months after screening. The primary end point of change in immunization recommendation acceptance rates between 2014 and 2015 was analyzed using a chi-square test; secondary objectives included changes in consent rates and thematic analysis of reported barriers. Results A total of 1016 patients were screened. Of these, 403 (39.7%) patients gave consent for student pharmacists to follow-up on vaccine recommendations. The overall recommendation acceptance rate was 27%, with approximately 46% of patients accepting at least 1 recommendation. Acceptance rates significantly decreased in the second year (36.5% vs 23.5%, P < .001), while consent for follow-up significantly increased (20% vs 64%, P < .001). Commonly reported barriers to immunization included resistance to vaccines, forgetfulness, and cost. Conclusion This algorithm provided a method for novice users to initiate conversations with patients about immunizations and may allow novices to act as pharmacist extenders to improve immunization rates.
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Affiliation(s)
- Brandi L. Bowers
- Division of Pharmacy Practice and Administration, University of Missouri–Kansas City School of Pharmacy, Kansas, MO, USA
| | - Jordan M. Rowe
- Division of Pharmacy Practice and Administration, University of Missouri–Kansas City School of Pharmacy, Kansas, MO, USA
| | - Rachel A. Stafford
- Department of Pharmacy Practice, University of Missouri–Kansas City School of Pharmacy, Kansas, MO, USA
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Implementation of the Standards for adult immunization practice: A survey of U.S. Health care providers. Vaccine 2020; 38:5305-5312. [PMID: 32586760 DOI: 10.1016/j.vaccine.2020.05.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 01/10/2023]
Abstract
The revised Standards for Adult Immunization Practice ("Standards"), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists. Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices.
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Darr AY, Gottfried S. Identifying vaccination rates of adult patients in ambulatory care clinics. SAGE Open Med 2020; 8:2050312120935461. [PMID: 32612828 PMCID: PMC7307275 DOI: 10.1177/2050312120935461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/22/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND While pharmacists have provided vaccinations to patients in the community pharmacy setting, pharmacist involvement within the medical office setting is not well documented in the literature. The American Society of Health-System Pharmacists reports that ambulatory care pharmacists are screening for and administering vaccinations at a declining rate, despite standards of practice. Vaccination rates for adults 19-64 years of age remain low, based on Healthy People 2020 goals, putting them at risk for vaccine-preventable diseases. OBJECTIVES The aim of the study was to assess vaccination rates of ambulatory care pharmacy clinic patients aged 19-64 years and to compare the rates between three clinics and to Healthy People 2020 goals. METHODS This was a baseline retrospective analysis of vaccination rates for patients aged 19-64 years who attended at least one pharmacy clinic visit at one of the three medical office practices. Age, sex, medical conditions, cigarette or alcohol use, immunosuppressive medications, and vaccines recommended and received were recorded. Vaccination status was assessed according to the Advisory Committee for Immunization Practices recommendations. Data were collected from January 2016 to March 2017. The percentage of eligible patients who received each vaccine was determined overall and for each clinic. RESULTS There were 240 patients who met the inclusion criteria, with a mean age of 52.8 years. The percentage of patients with vaccination documented in the medical record was 25% for pneumococcal conjugate, 35.7% for pneumococcal polysaccharide, 26.9% for zoster vaccine live, 6.4% for hepatitis B, and 50.6% for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. Vaccination rates for pneumococcal conjugate, pneumococcal polysaccharide, and zoster vaccine live were below established Healthy People 2020 goals. CONCLUSION Vaccination rates remain low in adults 19-64 years of age. Ambulatory care pharmacists should consider assessing vaccination status during clinic visits as a component of comprehensive vaccination programs.
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Affiliation(s)
- Amber Y Darr
- Department of Pharmacy Practice, Bernard
J. Dunn School of Pharmacy, Shenandoah University, Winchester, USA
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14
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Brackney MM, Gargano JW, Hannagan SE, Meek J, Querec TD, Niccolai LM. Human Papillomavirus 16/18-Associated Cervical Lesions: Differences by Area-Based Measures of Race and Poverty. Am J Prev Med 2020; 58:e149-e157. [PMID: 32001053 DOI: 10.1016/j.amepre.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This analysis evaluates trends in cervical lesions with human papillomavirus 16/18 detected by area-based measures of race, ethnicity, and poverty during 2008-2015. METHODS Trends in the proportion of lesions with human papillomavirus 16/18 detected among residents of New Haven County, Connecticut were examined by area-based measures of race, ethnicity, and poverty. Area-based measures are aggregate descriptors of census tract characteristics useful for measuring differences in health outcomes in the context of where people live. Multivariable logistic regression modeling was conducted, adjusted for individual-level race, ethnicity, and insurance status to assess the independent effects of area-based measures. Data were analyzed in 2018-2019. RESULTS Among women aged 21-24 years and 25-29 years, significant declines in the proportion of lesions with human papillomavirus 16/18 were observed. Among women aged 21-24 years, declines began earlier and were greater in magnitude in areas of lower poverty (OR=0.55, 95% CI=0.36, 0.85 for 2010-2012 vs 2008-2009 and OR=0.30, 95% CI=0.18, 0.51 for 2013-2015 vs 2008-2009) compared with higher poverty (OR=1.66, 95% CI=0.86, 3.21 and OR=0.48, 95% CI=0.19, 1.20). Similar patterns were observed for women aged 25-29 years, and for area-based measures of race and ethnicity. CONCLUSIONS Differences were observed in declines in the proportion of human papillomavirus 16/18 lesions by area-based measures since the introduction of human papillomavirus vaccines, with greater and earlier declines in areas with fewer residents living in poverty and racial minorities. Ongoing human papillomavirus vaccine impact monitoring is necessary to track differences by sociodemographic characteristics.
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Affiliation(s)
- Monica M Brackney
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut.
| | - Julia W Gargano
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan E Hannagan
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Troy D Querec
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda M Niccolai
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
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Granade CJ, McCord RF, Bhatti AA, Lindley MC. State Policies on Access to Vaccination Services for Low-Income Adults. JAMA Netw Open 2020; 3:e203316. [PMID: 32338751 PMCID: PMC7186857 DOI: 10.1001/jamanetworkopen.2020.3316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/21/2020] [Indexed: 01/05/2023] Open
Abstract
Importance State vaccination benefits coverage and access for adult Medicaid beneficiaries vary substantially. Multiple studies have documented lower vaccination uptake in publicly insured adults compared with privately insured adults. Objective To evaluate adult Medicaid beneficiaries' access to adult immunization services through review of vaccination benefits coverage in Medicaid programs across the 50 states and the District of Columbia. Design, Setting, and Participants A public domain document review with supplemental semistructured telephone survey was conducted between June 1, 2018, and June 14, 2019, to evaluate vaccination services benefits in fee-for-service and managed care organization arrangements for adult Medicaid beneficiaries in the 50 states and the District of Columbia (total, 51 Medicaid programs). Exposures Document review of benefits coverage for adult immunization services and supplemental survey with validation of document review findings. Main Outcomes and Measures Benefits coverage for adult Medicaid beneficiaries and reimbursement amounts for vaccine purchase and administration. Results Public domain document review was completed for all 51 jurisdictions. Among these, 44 Medicaid programs (86%) validated document review findings and completed the survey. Only 22 Medicaid programs (43%) covered all 13 Advisory Committee on Immunization Practices-recommended adult immunizations under both fee-for-service and managed care organization arrangements. Most fee-for-service arrangements (37 of 49) reimbursed health care professionals using any of the 4 approved vaccine administration codes; however, 8 of 49 programs did not separately reimburse for vaccine administration to adult Medicaid beneficiaries. Depending on administration route, median reimbursement for adult vaccine administration ranged from $9.81 to $13.98 per dose. Median per-dose reimbursement for adult vaccine purchase was highest for 9-valent human papillomavirus vaccine ($204.87) and lowest for Haemophilus influenzae type b vaccine ($18.09). Median reimbursement was below the private sector price for 7 of the 13 included vaccines. Conclusions and Relevance Even in programs with complete vaccination benefits coverage, reimbursement amounts to health care professionals for vaccine purchase and administration may not fully cover vaccination provision costs. Reimbursement amounts below costs may reduce incentives for health care professionals to vaccinate low-income adults and thereby limit Medicaid adult beneficiary access to vaccination.
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Affiliation(s)
- Charleigh J. Granade
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Department of Energy, Washington, DC
- Now with IHRC Inc, Atlanta, Georgia
| | - Russell F. McCord
- Public Health Law Program, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia
- Cherokee Nation Assurance, Arlington, Virginia
| | - Alexandra A. Bhatti
- Public Health Law Program, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia
- Cherokee Nation Assurance, Arlington, Virginia
- Now with Global Policy, Communications & Population Health, Merck & Co Inc, North Wales, Pennsylvania
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Beal JL, Kadakia NN, Reed JB, Illingworth Plake KS. Pharmacists’ impact on older adults’ access to vaccines in the United States. Vaccine 2020; 38:2456-2465. [DOI: 10.1016/j.vaccine.2020.01.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
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Yacoob Z, Cook C, Kotovicz F, Kram JJ, Klumph M, Stanley M, Hunter P, Baumgardner DJ. Enhancing Immunization Rates in Two Urban Academic Primary Care Clinics: A Before and After Assessment. J Patient Cent Res Rev 2020; 7:47-56. [PMID: 32002447 PMCID: PMC6988711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Immunization rates in many cities in the United States remain suboptimal compared to Healthy People 2020 Goals and are lower than national averages. This study aimed to determine whether a lecture-based educational intervention targeted at nurses and medical assistants would improve vaccination rates. METHODS We conducted a quality improvement study in two urban academic family medicine clinics serving a predominantly Medicaid patient population as well as a sizable proportion of refugees. The intervention consisted of 3 lectures that were delivered to clinic nurses and medical assistants. Vaccinations in 1689 patients - 872 in the 3-month preintervention period, 817 in the 3-month postintervention period - were analyzed. RESULTS Following the educational intervention, a statistically significant increase was seen only in human papillomavirus vaccine immunization rates for 13-18-year-olds (from 90.7% [n=54] to 100% [n=45]; P=0.036). When the results were stratified by clinic, only 1 site showed statistically significant increases in: pneumococcal polysaccharide vaccine (23-valent) for high-risk 19-to-64-year-olds (from 36.4% [n=154] to 47.8% [n=136]; P=0.049); Haemophilus influenzae type B vaccine for 2-month-to-5-year-olds (from 91.1% [n=112] to 97.3% [n=111]; P=0.048); and meningococcal conjugate vaccine (quadrivalent) for 13-18-year olds (from 85.2% [n=27] to 100% [n=26]; P=0.042). No increases were seen for our study's refugee patient population (n=171), and a significant decrease of the second-dose measles, mumps, and rubella vaccine (P=0.036) occurred in this subcohort. CONCLUSIONS Ultimately, this quality improvement study demonstrated that educational interventions alone have a limited impact on increasing immunization rates.
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Affiliation(s)
- Zeeshan Yacoob
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Christopher Cook
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Fabiana Kotovicz
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Jessica J.F. Kram
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
| | - Marianne Klumph
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
| | - Marisa Stanley
- Eau Claire City-County Health Department, Eau Claire, WI
| | - Paul Hunter
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- City of Milwaukee Health Department, Milwaukee, WI
| | - Dennis J. Baumgardner
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
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Bach AT, Kang AY, Lewis J, Xavioer S, Portillo I, Goad JA. Addressing common barriers in adult immunizations: a review of interventions. Expert Rev Vaccines 2019; 18:1167-1185. [PMID: 31791159 DOI: 10.1080/14760584.2019.1698955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Low levels of adult vaccination have been documented in the United States and globally. Research has been conducted to identify reasons for low immunization rates; however, the most useful studies are those that implemented interventions for identified barriers to evaluate their impact on rates of immunization. Identifying successful interventions provides immunization providers with evidence-based methods that can be utilized to increase the uptake of recommended vaccines.Areas covered: This review focuses on known barriers to adult immunizations and the interventions available in the literature to overcome these barriers. It outlines interventions that may increase vaccine uptake in the adult population through addressing barriers related to lack of vaccine knowledge, cost, access, provider and practice-based challenges, and racial and ethnic disparities.Expert opinion: Improving adult immunization rates is critical to protecting a population against vaccine-preventable diseases. Those interventions that appeared to increase immunization rates in the adult population included education and reminders about vaccination using text and telephone calls, low-cost or subsidized vaccines, easy access to immunization services, and understanding the cultural and social needs of different racial and ethnic populations. It is likely that an evidence-based multimodal approach using different categories of interventions is necessary to significantly improve adult immunization rates.
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Affiliation(s)
- Albert T Bach
- Assistant Professor of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, CA, USA
| | - Amy Y Kang
- Assistant Professor of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, CA, USA
| | - Jelena Lewis
- Assistant Professor of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, CA, USA
| | - Sharon Xavioer
- Assistant Professor of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, CA, USA
| | - Ivan Portillo
- AHIP Health Sciences Librarian, Leathery Libraries, Chapman University, Irvine, CA, USA
| | - Jeffery A Goad
- Chair of the Department of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, CA, USA
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Hutton DW, Rose A, Singer DC, Bridges CB, Kim D, Pike J, Prosser LA. Importance of reasons for stocking adult vaccines. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:e334-e341. [PMID: 31747238 PMCID: PMC9004468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To identify the most important reasons underlying decisions to stock or not stock adult vaccines. STUDY DESIGN US physicians, nurses, pharmacists, and administrators of internal medicine, family medicine, obstetrics/gynecology, and multispecialty practices who were involved in vaccine stocking decisions (N = 125) completed a best-worst scaling survey online between February and April 2018. METHODS Sixteen potential factors influencing stocking decisions were developed based on key informant interviews and focus groups. Respondents selected factors that were most and least important in vaccine stocking decisions. Relative importance scores for the best-worst scaling factors were calculated. Survey respondents described which vaccines their practice stocks and reasons for not stocking specific vaccines. Subgroup analyses were performed based on the respondent's involvement in vaccine decision making, role in the organization, specialty, and affiliation status, as well as practice characteristics such as practice size, insurance mix, and patient age mix. RESULTS Relative importance scores for stocking vaccines were highest for "cost of purchasing vaccine stock," "expense of maintaining vaccine inventory," and "lack of adequate reimbursement for vaccine acquisition and administration." Most respondents (97%) stocked influenza vaccines, but stocking rates of other vaccines varied from 39% (meningococcal B) to 83% (tetanus-diphtheria-pertussis). Best-worst scaling results were consistent across respondent subgroups, although the range of vaccine types stocked differed by practice type. CONCLUSIONS Economic factors associated with the purchase and maintenance of vaccine inventory and inadequate reimbursement for vaccination services were the most important to decision makers when considering whether to stock or not stock vaccines for adults.
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Affiliation(s)
- David W Hutton
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Room M3525, Ann Arbor, MI 48109-2029.
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Goodman RM, Bridges CB, Kim D, Pike J, Rose A, Prosser LA, Hutton DW. Billing and payment of commercial and Medicaid health plan adult vaccination claims in Michigan since the Affordable Care Act. Vaccine 2019; 37:6803-6813. [PMID: 31585724 DOI: 10.1016/j.vaccine.2019.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Provider concern regarding insurance non-payment for vaccines is a common barrier to provision of adult immunizations. We examined current adult vaccination billing and payment associated with two managed care populations to identify reasons for non-payment of immunization insurance claims. METHODS We assessed administrative data from 2014 to 2015 from Blue Care Network of Michigan, a nonprofit health maintenance organization, and Blue Cross Complete of Michigan, a Medicaid managed care plan, to determine rates of and reasons for non-payment of adult vaccination claims across patient-care settings, insurance plans, and vaccine types. We compared commercial and Medicaid payment rates to Medicare payment rates and examined patient cost sharing. RESULTS Pharmacy-submitted claims for adult vaccine doses were almost always paid (commercial 98.5%; Medicaid 100%). As the physician office accounted for the clear majority (79% commercial; 69% Medicaid) of medical (non-pharmacy) vaccination services, we limited further analyses of both commercial and Medicaid medical claims to the physician office setting. In the physician office setting, rates of payment were high with commercial rates of payment (97.9%) greater than Medicaid rates (91.6%). Reasons for non-payment varied, but generally related to the complexity of adult vaccine recommendations (patient diagnosis does not match recommendations) or insurance coverage (complex contracts, multiple insurance payers). Vaccine administration services were also generally paid. Commercial health plan payments were greater for both vaccine dose and vaccine administration than Medicare payments; Medicaid paid a higher amount for the vaccine dose, but less for vaccine administration than Medicare. Patients generally had very low (commercial) or no (Medicaid) cost-sharing for vaccination. CONCLUSIONS Adult vaccine dose claims were usually paid. Medicaid generally had higher rates of non-payment than commercial insurance.
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Affiliation(s)
- Robert M Goodman
- Blue Care Network/Blue Cross Blue Shield of Michigan, Southfield, MI, United States
| | - Carolyn B Bridges
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States; Berry Technology Solutions, Inc., Peachtree City, GA, United States(1)
| | - David Kim
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States
| | - Jamison Pike
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States
| | - Angela Rose
- University of Michigan, Ann Arbor, MI, United States
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Vaccination Capability Inventory of Community, Migrant, and Homeless Health Centers: A Survey Report. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 26:139-147. [PMID: 31490854 DOI: 10.1097/phh.0000000000001073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Federally funded Community, Migrant, and Homeless Health Centers provide health services to the most vulnerable communities in the United States. However, little is known about their capabilities and processes for providing vaccinations to adults. PROGRAM We conducted the first national survey of health centers assessing their inventory, workflow, capacity for, and barriers to provision of routinely recommended adult vaccines. In addition, we asked health center leaders' perceptions regarding best practices and policy recommendations for adult vaccinations. IMPLEMENTATION A survey was developed on the basis of domains elicited from advisory panels and focus groups and was sent electronically to leaders of 762 health centers throughout the United States and its territories; data were collected and analyzed in 2018. EVALUATION A total of 319 survey responses (42%) were obtained. Health centers reported stocking most routinely recommended vaccines for adults; zoster vaccines were not stocked regularly due to supply and storage issues. Respondents most commonly reported adequate reimbursement for vaccination services from private insurance and Medicaid. Most vaccinations were provided during primary care encounters; less than half of health centers reported providing vaccines during specialist visits. Vaccines administered at the health center were most commonly documented in an open field of the electronic health record (96%) or in an immunization information system (72%). Recommendations for best practices related to better documentation of vaccinations and communication with immunization information systems were provided. DISCUSSION Health centers provide most adult vaccines to their patients despite financial and technological barriers to optimal provisioning. Further studies at point of care could help identify mechanisms for system improvements.
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Yarnoff B, Khavjou O, King G, Bates L, Zhou F, Leidner AJ, Shen AK. Analysis of the profitability of adult vaccination in 13 private provider practices in the United States. Vaccine 2019; 37:6180-6185. [PMID: 31495594 DOI: 10.1016/j.vaccine.2019.08.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/05/2023]
Abstract
Vaccination coverage among adults remains low in the United States. Understanding the barriers to provision of adult vaccination is an important step to increasing vaccination coverage and improving public health. To better understand financial factors that may affect practice decisions about adult vaccination, this study sought to understand how costs compared with payments for adult vaccinations in a sample of U.S. physician practices. We recruited a convenience sample of 19 practices in nine states in 2017. We conducted a time-motion study to assess the time costs of vaccination activities and conducted a survey of practice managers to assess materials, management, and dose costs and payments for vaccination. We received complete cost and payment data from 13 of the 19 practices. We calculated annual income from vaccination services by comparing estimated costs with payments received for vaccine doses and vaccine administration. Median annual total income from vaccination services was $90,343 at family medicine practices (range: $3968-$249,628), $28,267 at internal medicine practices (-$32,659-$141,034) and $2886 at obstetrics and gynecology practices (-$73,451-$23,820). Adult vaccination was profitable at the median of our sample, but there is wide variation in profitability due to differences in costs and payment rates across practices. This study provides evidence on the financial viability of adult vaccination and supports actions for improving financial viability. These results can help inform practices' decisions whether to provide adult vaccines and contribute to keeping adults up-to-date with the recommended vaccination schedule.
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Affiliation(s)
| | - Olga Khavjou
- RTI International, Research Triangle Park, NC, United States
| | - Grant King
- RTI International, Research Triangle Park, NC, United States
| | - Laurel Bates
- RTI International, Research Triangle Park, NC, United States
| | - Fangjun Zhou
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Angela K Shen
- National Vaccine Program Office, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC, United States
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Tsai Y, Zhou F, Lindley MC. Insurance Reimbursements for Routinely Recommended Adult Vaccines in the Private Sector. Am J Prev Med 2019; 57:180-190. [PMID: 31248743 PMCID: PMC6732785 DOI: 10.1016/j.amepre.2019.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Financial concerns are frequently cited by providers as a barrier to adult vaccination. This study assessed insurance reimbursements to providers for administering vaccines to adults in the private sector. METHODS This study, conducted in 2018, used the 2016 MarketScan Commercial Claims and Encounters Database and included vaccination visits made by adults aged 19-64 years. Four routinely recommended vaccines targeted at adults were included: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); tetanus and diphtheria toxoids (Td); zoster; and influenza. The mean reimbursements for vaccine purchase and administration were reported and examined by state, metropolitan statistical area, provider type, and insurance plan type. Using the private vaccine purchase price published by the Centers for Disease Control and Prevention (CDC), the study reported the proportion of vaccination visits receiving reimbursements above the CDC-published price. RESULTS The mean vaccine administration reimbursement was $25.80 for the first dose and $14.71 for additional doses in the same visit. The mean vaccine purchase reimbursement was $44.15 for Tdap, $25.78 for Td, and $216.05 for the zoster vaccine; the unweighted mean for the four examined influenza vaccines was $17.25. Reimbursements varied widely by state. Vaccine reimbursements exceeded the CDC-published price for most visits where Tdap (71.4%), zoster (87.8%), and three of four influenza (61.5%-88.5%) vaccines were administered but only for 25.8% of visits where Td was given. CONCLUSIONS On average, reimbursements for administering vaccines to privately insured adults were adequate for most private practices. However, providers' financial concerns may vary across geographic locations.
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Affiliation(s)
- Yuping Tsai
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Fangjun Zhou
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Prosser LA, Harpaz R, Rose AM, Gebremariam A, Guo A, Ortega-Sanchez IR, Zhou F, Dooling K. A Cost-Effectiveness Analysis of Vaccination for Prevention of Herpes Zoster and Related Complications: Input for National Recommendations. Ann Intern Med 2019; 170:380-388. [PMID: 30776797 DOI: 10.7326/m18-2347] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The U.S. Advisory Committee on Immunization Practices recently developed recommendations for use of a new recombinant zoster vaccine (RZV). OBJECTIVE To evaluate the cost-effectiveness of vaccination with RZV compared with zoster vaccine live (ZVL) and no vaccination, the cost-effectiveness of vaccination with RZV for persons who have previously received ZVL, and the cost-effectiveness of preferential vaccination with RZV over ZVL. DESIGN Simulation (state-transition) model using U.S. epidemiologic, clinical, and cost data. DATA SOURCES Published data. TARGET POPULATION Hypothetical cohort of immunocompetent U.S. adults aged 50 years or older. TIME HORIZON Lifetime. PERSPECTIVE Societal and health care sector. INTERVENTION Vaccination with RZV (recommended 2-dose regimen), vaccination with ZVL, and no vaccination. OUTCOME MEASURES The primary outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS OF BASE-CASE ANALYSIS For vaccination with RZV compared with no vaccination, ICERs ranged by age from $10 000 to $47 000 per quality-adjusted life-year (QALY), using a societal perspective and assuming 100% completion of the 2-dose RZV regimen. For persons aged 60 years or older, ICERs were less than $60 000 per QALY. Vaccination with ZVL was dominated by vaccination with RZV for all age groups 60 years or older. RESULTS OF SENSITIVITY ANALYSIS Results were most sensitive to changes in vaccine effectiveness, duration of protection, herpes zoster incidence, and probability of postherpetic neuralgia. Vaccination with RZV after previous administration of ZVL yielded an ICER of less than $60 000 per QALY for persons aged 60 years or older. In probabilistic sensitivity analyses, RZV remained the preferred strategy in at least 95% of simulations, including those with 50% completion of the second dose. LIMITATION Few data were available on risk for serious adverse events, adherence to the recommended 2-dose regimen, and probability of recurrent zoster. CONCLUSION Vaccination with RZV yields cost-effectiveness ratios lower than those for many recommended adult vaccines, including ZVL. Results are robust over a wide range of plausible values. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center at University of Michigan Medical School and University of Michigan School of Public Health, Ann Arbor, Michigan (L.A.P.)
| | - Rafael Harpaz
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., A.G., I.R.O., F.Z., K.D.)
| | - Angela M Rose
- Susan B. Meister Child Health Evaluation and Research Center at University of Michigan Medical School, Ann Arbor, Michigan (A.M.R., A.G.)
| | - Acham Gebremariam
- Susan B. Meister Child Health Evaluation and Research Center at University of Michigan Medical School, Ann Arbor, Michigan (A.M.R., A.G.)
| | - Angela Guo
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., A.G., I.R.O., F.Z., K.D.)
| | - Ismael R Ortega-Sanchez
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., A.G., I.R.O., F.Z., K.D.)
| | - Fangjun Zhou
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., A.G., I.R.O., F.Z., K.D.)
| | - Kathleen Dooling
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., A.G., I.R.O., F.Z., K.D.)
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Administration, Billing, and Payment for Pharmacy Student-Based Immunizations to Medicare Beneficiaries at Mobile Medicare Clinics. PHARMACY 2019; 7:pharmacy7010022. [PMID: 30823519 PMCID: PMC6473748 DOI: 10.3390/pharmacy7010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/24/2022] Open
Abstract
Training student pharmacists to administer vaccinations requires a substantial investment in vaccines, supplies, and time. Few schools of pharmacy seek out or receive any reimbursement for the provision of vaccines, despite the fact it is a covered service. This study sought to implement, deliver, and demonstrate an innovative, financially sustainable curriculum-based immunization program by trained pharmacy students as part of their experiential learning. Thirty-nine community health clinics targeting Medicare beneficiaries were conducted throughout Northern/Central California during Medicare’s fall open enrollment periods between 2014–2016. American Pharmacists Association (APhA)-trained student pharmacists (under licensed pharmacist supervision) administered 1777 vaccinations. Vaccines were billed via a secure Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant web-based portal. The total net income was $11,905 and $8032 for 2015 and 2016, respectively. Return on investment was greatest for the influenza vaccine > Tdap > pneumococcal. Pharmacy students are already being trained to provide immunizations and can utilize their skills to deliver financially viable public health programs.
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Srivastav A, Black CL, Lutz CS, Fiebelkorn AP, Ball SW, Devlin R, Pabst LJ, Williams WW, Kim DK. U.S. clinicians' and pharmacists' reported barriers to implementation of the Standards for Adult Immunization Practice. Vaccine 2018; 36:6772-6781. [PMID: 30243501 PMCID: PMC6397956 DOI: 10.1016/j.vaccine.2018.09.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/07/2018] [Accepted: 09/12/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Standards for Adult Immunization Practice (Standards), revised in 2014, emphasize that adult-care providers assess vaccination status of adult patients at every visit, recommend vaccination, administer needed vaccines or refer to a vaccinating provider, and document vaccinations administered in state/local immunization information systems (IIS). Providers report numerous systems- and provider-level barriers to vaccinating adults, such as billing, payment issues, lower prioritization of vaccines due to competing demands, and lack of information about the use and utility of IIS. Barriers to vaccination result in missed opportunities to vaccinate adults and contribute to low vaccination coverage. Clinicians' (physicians, physician assistants, nurse practitioners) and pharmacists' reported barriers to assessment, recommendation, administration, referral, and documentation, provider vaccination practices, and perceptions regarding their adult patients' attitudes toward vaccines were evaluated. METHODS Data from non-probability-based Internet panel surveys of U.S. clinicians (n = 1714) and pharmacists (n = 261) conducted in February-March 2017 were analyzed using SUDAAN. Weighted proportion of reported barriers to assessment, recommendation, administration, referral, and documentation in IIS were calculated. RESULTS High percentages (70.0%-97.4%) of clinicians and pharmacists reported they routinely assessed, recommended, administered, and/or referred adults for vaccination. Among those who administered vaccines, 31.6% clinicians' and 38.4% pharmacists' submitted records to IIS. Reported barriers included: (a) assessment barriers: vaccination of adults is not within their scope of practice, inadequate reimbursement for vaccinations; (b) administration barriers: lack of staff to manage/administer vaccines, absence of necessary vaccine storage and handling equipment and provisions; and (c) documentation barriers: unaware if state/city has IIS that includes adults or not sure how their electronic system would link to IIS. CONCLUSION Although many clinicians and pharmacists reported implementing most of the individual components of the Standards, with the exception of IIS use, there are discrepancies in providers' reported actual practices and their beliefs/perceptions, and barriers to vaccinating adults remain.
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Affiliation(s)
- Anup Srivastav
- Leidos Inc., 2295 Parklake Drive NE #300, Atlanta, GA 30345-2844, USA; Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA.
| | - Carla L Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA
| | - Chelsea S Lutz
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA; Oak Ridge Institute for Science and Education, United States Department of Energy, 100 ORAU Way, Oak Ridge, TN 37830-6209, USA
| | - Amy Parker Fiebelkorn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA
| | - Sarah W Ball
- Abt Associates Inc., 55 Wheeler Street, Cambridge, MA 02138-1192, USA
| | - Rebecca Devlin
- Abt Associates Inc., 55 Wheeler Street, Cambridge, MA 02138-1192, USA
| | - Laura J Pabst
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA
| | - David K Kim
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA
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Hurley LP, Allison MA, Dooling KL, O'Leary ST, Crane LA, Brtnikova M, Beaty BL, Allen JA, Guo A, Lindley MC, Kempe A. Primary care physicians' experience with zoster vaccine live (ZVL) and awareness and attitudes regarding the new recombinant zoster vaccine (RZV). Vaccine 2018; 36:7408-7414. [PMID: 30420121 DOI: 10.1016/j.vaccine.2018.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/20/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Advisory Committee on Immunization Practices (ACIP) has routinely recommended zoster vaccine live (ZVL) for adults ≥60 since 2008; only 33% of eligible adults received it by 2016. A recombinant zoster vaccine (RZV) was licensed in 2017 and ACIP recommended in January 2018. Our objectives were to assess among primary care physicians (1) practices and attitudes regarding ZVL and (2) awareness of RZV. METHODS We administered an Internet and mail survey from July to September 2016 to national networks of 953 primary care physicians. RESULTS Response rate was 65% (603/923). Ninety-three % of physicians recommended ZVL to adults ≥60, but fewer recommended it to adults ≥60 with a prior history of zoster (88%), adults > 85 (62%) and adults ≥60 on low-dose methotrexate (42%). Several physicians recommended ZVL in ways that are not recommended by ACIP including to adults 50-59 (50%), adults ≥60 with HIV (33%), and adults ≥60 on high dose prednisone (≥20 mg/day) (27%). Nineteen percent of physicians stocked and administered ZVL and did not refer patients elsewhere for vaccination, 37% did not stock and only referred patients to receive it, and 44% both stocked/administered and referred elsewhere. Twenty-three % (n = 115) of physicians who had ever administered ZVL in the office (n = 490) had stopped, citing primarily financial issues (90%). Only 5% were 'very aware' of RZV. CONCLUSIONS Physicians report not recommending ZVL to certain ACIP-recommended groups, but report recommending it to some groups for which the vaccine should be avoided. Implementation of recommendations for RZV will need to consider financial barriers and the complex patchwork of office-based and pharmacy delivery ZVL has encountered.
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Affiliation(s)
- Laura P Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Division of General Internal Medicine, Denver Health, Denver, CO, United States.
| | - Mandy A Allison
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kathleen L Dooling
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lori A Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States
| | - Jessica A Allen
- Office of the Associate Director for Communication, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Angela Guo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Lutz CS, Kim DK, Black CL, Ball SW, Devlin RG, Srivastav A, Fiebelkorn AP, Bridges CB. Clinicians' and Pharmacists' Reported Implementation of Vaccination Practices for Adults. Am J Prev Med 2018; 55:308-318. [PMID: 30054198 PMCID: PMC6166242 DOI: 10.1016/j.amepre.2018.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/31/2018] [Accepted: 05/02/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Despite the proven effectiveness of immunization in preventing morbidity and mortality, adult vaccines remain underutilized. The objective of this study was to describe clinicians' and pharmacists' self-reported implementation of the Standards for Adult Immunization Practice ("the Standards"; i.e., routine assessment, recommendation, and administration/referral for needed vaccines, and documentation of administered vaccines, including in immunization information systems). METHODS Two Internet panel surveys (one among clinicians and one among pharmacists) were conducted during February-March 2017 and asked respondents about their practice's implementation of the Standards. T-tests assessed associations between clinician medical specialty, vaccine type, and each component of the Standards (March-August 2017). RESULTS Implementation of the Standards varied substantially by vaccine and provider type. For example, >80.0% of providers, including obstetrician/gynecologists and subspecialists, assessed for and recommended influenza vaccine. However, 24.3% of obstetrician/gynecologists and 48.9% of subspecialists did not stock influenza vaccine for administration. Although zoster vaccine was recommended by >89.0% of primary care providers, <58.0% stocked the vaccine; by contrast, 91.6% of pharmacists stocked zoster vaccine. Vaccine needs assessments, recommendations, and stocking/referrals also varied by provider type for pneumococcal; tetanus, diphtheria, acellular pertussis; tetanus diphtheria; human papillomavirus; and hepatitis B vaccines. CONCLUSIONS This report highlights gaps in access to vaccines recommended for adults across the spectrum of provider specialties. Greater implementation of the Standards by all providers could improve adult vaccination rates in the U.S. by reducing missed opportunities to recommend vaccinations and either vaccinate or refer patients to vaccine providers.
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Affiliation(s)
- Chelsea S Lutz
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, U.S. Department of Energy, Washington, District of Columbia.
| | - David K Kim
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carla L Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Anup Srivastav
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Leidos Inc., Atlanta, Georgia
| | - Amy Parker Fiebelkorn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn B Bridges
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Berry Technology Solutions, Inc., Peachtree City, Georgia
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Weiser T, Bacon A, Corum B, Van Lew H, Groom A. Evaluation of an adult immunization composite measure in the Indian Health Service. Vaccine 2018; 36:4952-4957. [DOI: 10.1016/j.vaccine.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/12/2018] [Accepted: 04/03/2018] [Indexed: 10/28/2022]
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Abstract
Life-long primary prevention interventions beginning and continuing throughout an individual's lifetime are increasingly seen as key to meeting the global healthcare challenges that accompany demographic changes - a concept referred to as "Healthy aging". In this perspective, vaccination is seen as part of a triad, together with healthy diet and exercise. Current adult vaccine coverage is lower than target vaccination rates in most developed countries, and so vaccine preventable diseases continue to present a substantial burden on health and healthcare resources, especially in older individuals. In part, this is due to lack of knowledge and understanding of the benefits of vaccination, inconsistent recommendations by providers and uncertainties about cost benefits. However, lower vaccine effectiveness in older adults plays a part, and new vaccines with novel characteristics to improve effectiveness in older adults are required. A life-course immunization approach to ensure optimal vaccine uptake across adults of all ages can be expected to reduce morbidity and mortality in later life. To achieve this, greater emphasis on public and healthcare provider education is necessary, based on appropriate economic analyses that demonstrate the overall value of vaccination. This article introduces the technical, economic, political and demographic issues that make establishing effective adult vaccination programs such a difficult, but pressing issue, and outlines some of the steps that are now being taken to address them. Key messages Life-long preventive activities that start and continue throughout life are essential, especially as the world's population is "getting older". This "Healthy aging" approach includes not only healthy diet and physical exercise; vaccination is critical in reducing some infectious diseases and their complications. Many adults, especially older adults (who have lower immunity than younger people) develop infections such as influenza and shingles that could potentially be prevented through vaccination. This review provides a perspective on the challenges in delivering a life-course immunization program. While some vaccines are less effective in older people, newer vaccines have been developed which provide stronger and longer protection in older patients than standard existing vaccines. However, the benefits of vaccination can only be realized if the vaccines are recommended and used. For that purpose, greater education of patients and their healthcare providers is necessary. Better knowledge of vaccines and making sure that all adults are up to date with all their recommended vaccines is an essential part of "Healthy aging". This should prevent not only vaccine-preventable diseases but also reduce the risk of complications in later life.
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Affiliation(s)
| | | | - T Mark Doherty
- c Department of Medical Affairs , GlaxoSmithKline , Wavre , Belgium
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Lindley MC, Hurley LP, Beaty BL, Allison MA, Crane LA, Brtnikova M, Snow M, Bridges CB, Kempe A. Vaccine financing and billing in practices serving adult patients: A follow-up survey. Vaccine 2018; 36:1093-1100. [PMID: 29366706 PMCID: PMC5807000 DOI: 10.1016/j.vaccine.2018.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Financial concerns are often cited by physicians as a barrier to administering routinely recommended vaccines to adults. The purpose of this study was to assess perceived payments and profit from administering recommended adult vaccines and vaccine purchasing practices among general internal medicine (GIM) and family medicine (FM) practices in the United States. METHODS We conducted an interviewer-administered survey from January-June 2014 of practices stratified by specialty (FM or GIM), affiliation (standalone or ≥ 2 practice sites), and level of financial decision-making (independent or larger system level) in FM and GIM practices that responded to a previous survey on adult vaccine financing and provided contact information for follow-up. Practice personnel identified as knowledgeable about vaccine financing and billing responded to questions about payments relative to vaccine purchase price and payment for vaccine administration, perceived profit on vaccination, claim denial, and utilization of various purchasing strategies for private vaccine stocks. Survey items on payment and perceived profit were assessed for various public and private payer types. Descriptive statistics were calculated and responses compared by physician specialty, practice affiliation, and level of financial decision-making. RESULTS Of 242 practices approached, 43% (n = 104) completed the survey. Reported payment levels and perceived profit varied by payer type. Only for preferred provider organizations did a plurality of respondents report profiting on adult vaccination services. Over half of respondents reported losing money vaccinating adult Medicaid beneficiaries. One-quarter to one-third of respondents reported not knowing about Medicare Part D payment levels for vaccine purchase and vaccine administration, respectively. Few respondents reported negotiating with manufacturers or insurance plans on vaccine purchase prices or payments for vaccination. CONCLUSIONS Practices vaccinating adults may benefit from education and technical assistance related to vaccine financing and billing and greater use of purchasing strategies to decrease upfront vaccine cost.
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Affiliation(s)
- Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Laura P Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA; Division of General Internal Medicine, Denver Health, Denver, CO, USA
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Mandy A Allison
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Lori A Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Megan Snow
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Carolyn B Bridges
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
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Primary Care Physicians' Struggle with Current Adult Pneumococcal Vaccine Recommendations. J Am Board Fam Med 2018; 31:94-104. [PMID: 29330244 PMCID: PMC5774021 DOI: 10.3122/jabfm.2018.01.170216] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/17/2017] [Accepted: 08/31/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In 2012, the Advisory Committee on Immunization Practices recommended 13-valent pneumococcal conjugate vaccine (PCV13) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for at-risk adults ≥19; in 2014, it expanded this recommendation to adults ≥65. Primary care physicians' practice, knowledge, attitudes, and beliefs regarding these recommendations are unknown. METHODS Primary care physicians throughout the U.S. were surveyed by E-mail and post from December 2015 to January 2016. RESULTS Response rate was 66% (617 of 935). Over 95% of respondents reported routinely assessing adults' vaccination status and recommending both vaccines. A majority found the current recommendations to be clear (50% "very clear," 38% "somewhat clear"). Twenty percent found the upfront cost of purchasing PCV13, lack of insurance coverage, inadequate reimbursement, and difficulty determining vaccination history to be "major barriers" to giving these vaccines. Knowledge of recommendations varied, with 83% identifying the PCV13 recommendation for adults ≥65 and only 21% identifying the recommended interval between PCV13 and PPSV23 in an individual <65 at increased risk. CONCLUSIONS Almost all surveyed physicians reported recommending both pneumococcal vaccines, but a disconnect seems to exist between perceived clarity and knowledge of the recommendations. Optimal implementation of these recommendations will require addressing knowledge gaps and reported barriers.
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Abstract
Vaccines are important for preventing infections in adults aged ≥65 years. Older adults are at increased risk for complications from vaccine-preventable illnesses due to age-associated changes in immune function and chronic medical comorbidities. Vaccination rates for older adults remain low despite widely accepted practice guidelines. Recommended vaccinations for older adults include (1) influenza; (2) pneumococcal; (3) herpes zoster; (4) tetanus, diphtheria, pertussis; and (5) hepatitis B. Cost influences vaccination rates in older adults.
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Affiliation(s)
- Megan Burke
- Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, MFL Center Tower, Suite 2200, Baltimore, MD 21224, USA.
| | - Theresa Rowe
- General Internal Medicine and Geriatrics, Northwestern Feinberg School of Medicine, 750 North Lakeshore Drive, 10th Floor, Chicago, IL 60611, USA
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