Blog | Thursday, February 17, 2011

QD: News Every Day--Less than one-third of PCPs stock all adult vaccines


Less than one in three primary care practices offer all 10 recommended adult vaccines, citing a variety of financial and logistical reasons.

Researchers sponsored by the Centers for Disease Control and Prevention sampled 993 family physicians and 997 general internists. Of the respondents, 27% (31% of family practitioners and 20% of internists) stocked all 10. Results appear in the Feb. 17 issue of the journal Vaccine.

The 10 vaccines were hepatitis A; hepatitis B; human papillomavirus vaccine (HPV); combined measles, mumps, and rubella (MMR); meningococcal conjugate vaccine (MCV4); pneumococcal polysaccharide (PPSV23); tetanus diphtheria (Td); combined tetanus, diphtheria, and pertussis (Tdap); varicella; and zoster.

Of the responding practices, 2% plan to stop vaccine purchases, 12% plan to increase them and the rest had no plans to change their vaccination stocking habits. But physicians who identified themselves as their respective practices' decision makers for stocking vaccines were more likely to decrease the number of different vaccines stocked for adults (11% vs. 3%; P=.0001).

The National Vaccine Advisory Committee, a group that advises the various federal agencies involved in vaccines and immunizations, arrived at even bleaker figures in 2009, reported the April 2009 issue of ACP Internist. For example, 62% of decision makers in practices said they had delayed purchase of a vaccine at some time in the prior three years due to financial concerns. And in the prior year, 16% of practice decision makers had seriously considered stopping vaccinations for privately insured patients due to the cost and reimbursement issues.

The vaccines most frequently stocked were Td and PPSV23. Zoster was the least frequently stocked, with more than 40% of respondents citing inadequate reimbursement or inconsistent insurance coverage. For the other seven vaccines, internists were more likely (and sometimes nearly twice as likely) not to stock the vaccine than family practitioners. While many vaccines are more likely used among adolescents, the researchers noted, many internists still provide care to these patients and to young adults, forcing them to seek vaccination elsewhere.

Besides zoster, no single reason predominated to not stock a vaccine, leading researchers to conclude that no single financial action or policy change will likely have a significant positive impact. However, they did note that PPSV23 was a performance marker in the Healthcare Effectiveness Data and Information Set, and increasing the number of vaccines included in its measurements for adult patients might help.

Researcher wrote, "To fulfill the medical home concept, however, it would seem that primary care physicians should provide the full range of vaccines, including those that might be infrequently indicated."

ACP's tools for its Adult Immunization Initiative are online.

ACP's Center for Practice Improvement and Innovation offers an easy-to-follow primer on vaccination and vaccine management.