Physician Attitudes toward Adult Vaccines and other Preventive Practices,United States,2012

Abstract

Objectives.

We described the following among U.S. primary care physicians: (1) perceived importance of vaccines recommended by the Advisory Committee on Immunization Practices relative to U.S. Preventive Services Task Force (USPSTF) preventive services, (2) attitudes toward the U.S. adult immunization schedule, and (3) awareness and use of Medicare preventive service visits.

Methods.

We conducted an Internet and mail survey from March to June 2012 among national networks of general internists and family physicians.

Results.

We received responses from 352 of 445 (79%) general internists and 255 of 409 (62%) family physicians. For a 67-year-old hypothetical patient, 540/606 (89%, 95% confidence interval [CI] 87, 92) of physicians ranked seasonal influenza vaccine and 487/607 (80%, 95% CI 77, 83) ranked pneumococcal vaccine as very important, whereas 381/604 (63%, 95% CI 59, 67) ranked Tdap/Td vaccine and 288/607 (47%, 95% CI 43, 51) ranked herpes zoster vaccine as very important (p<0.001). All Grade A USPSTF recommendations were considered more important than Tdap/Td and herpes zoster vaccines. For the hypothetical patient aged 30 years, the number and percentage of physicians who reported that the Tdap/Td vaccine (377/604; 62%, 95% CI 59, 66) is very important was greater than the number and percentage who reported that the seasonal influenza vaccine (263/605; 43%, 95% CI 40, 47) is very important (p<0.001), and all Grade A and Grade B USPSTF recommendations were more often reported as very important than was any vaccine. A total of 172 of 587 physicians (29%) found aspects of the adult immunization schedule confusing. Among physicians aware of “Welcome to Medicare” and annual wellness visits, 492/514 (96%, 95% CI 94, 97) and 329/496 (66%, 95% CI 62, 70), respectively, reported having conducted fewer than 10 such visits in the previous month.

Conclusions.

Despite lack of prioritization of vaccines by ACIP, physicians are prioritizing some vaccines over others and ranking some vaccines below other preventive services. These attitudes and confusion about the immunization schedule may result in missed opportunities for vaccination. Medicare preventive visits are not being used widely despite offering a venue for delivery of preventive services, including vaccinations.

References

Preventive Services Task Force (US). What is the Task Force and what does it do? [cited 2014 Jul 24]. Available from: http://www.uspreventiveservicestaskforce.org/page/basiconecolumn/28.

Centers for Disease Control and Prevention (US). Advisory Committee on Immunization Practices (ACIP) [cited 2014 Jul 24]. Available from: http://www.cdc.gov/vaccines/acip.

Walton

Orenstein

Pickering

. The history of the United States Advisory Committee on Immunization Practices (ACIP). Vaccine 2015;33:405–14.

Smith

Hinman

Pickering

. History and evolution of the Advisory Committee on Immunization Practices—United States, 1964–2014. MMWR Morb Mortal Wkly Rep 2014;63(42):955–8.

Smith

Snider

Pickering

. Immunization policy development in the United States: The role of the Advisory Committee on Immunization Practices. Ann Intern Med 2009;150:45–9.

Ahmed

Temte

Campos-Outcalt

Schunemann

. Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). Vaccine 2011;29:9171–6.

Pham

Schrag

Hargraves

Bach

. Delivery of preventive services to older adults by primary care physicians. JAMA 2005;294:473–81.

Coates

Ogden

Monroe

Buehler

Yoon

Collins

. Conclusions and future directions for periodic reporting on the use of adult clinical preventive services of public health priority—United States. MMWR Morb Mortal Wkly Rep 2012;61 Suppl:73–8.

Williams

Greby

Bridges

Ahmed

Liang

, Noninfluenza vaccination coverage among adults—United States, 2011. MMWR Morb Mortal Wkly Rep 2013;62(4):66–72.

10.

Centers for Disease Control and Prevention (US). Flu vax view [cited 2014 Mar 17]. Available from: http://www.cdc.gov/flu/fluvaxview/index.htm.

11.

Coates

Yoon

Zaza

Ogden

Thacker

. Rationale for periodic reporting on the use of adult clinical preventive services of public health priority—United States. MMWR Morb Mortal Wkly Rep 2012;61(2):3–10.

12.

Centers for Disease Control and Prevention (US). Flu vaccination coverage, United States, 2013–14 influenza season [cited 2015 Feb 6]. Available from: http://www.cdc.gov/flu/fluvaxview/coverage-1314estimates.htm.

13.

Shaw

Asomugha

Conway

Rein

. The Patient Protection and Affordable Care Act: Opportunities for prevention and public health. Lancet 2014;384:75–82.

14.

Pub. L. No. 111–148, 124 Stat. 119 through 124 Stat. 1025 (2010).

15.

Fox

Shaw

. Clinical preventive services coverage and the Affordable Care Act. Am J Public Health 2015;105:e7–10.

16.

Centers for Medicare & Medicaid Services (US). The ABCs of providing the annual wellness visit [cited 2014 Oct 9]. Available from: http://www.cms.gov/outreach-and-education/medicare-learning-network-MLN/MLNproducts/downloads/AWV_chart_ICN905706.pdf.

17.

Centers for Medicare & Medicaid Services (US). Your “Welcome to Medicare” preventive visit [cited 2014 Oct 9]. Available from: http://www.medicare.gov/people-like-me/new-to-medicare/welcome-to-medicare-visit.html.

18.

Abbo

Zhang

Zelder

Huang

. The increasing number of clinical items addressed during the time of adult primary care visits. J Gen Intern Med 2008;23:2058–65.

19.

Ostbye

Yarnall

Krause

Pollak

Gradison

Michener

. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005;3:209–14.

20.

Dyrbye

West

Burriss

Shanafelt

. Providing primary care in the United States: The work no one sees. Arch Intern Med 2012;172:1420–1.

21.

Yarnall

Pollak

Ostbye

Krause

Michener

. Primary care: Is there enough time for prevention? Am J Public Health 2003;93:635–41.

22.

University of Colorado Children's Outcomes Research. Vaccine Policy Collaborative Initiative. 2014 [cited 2012 Oct 25]. Available from: http://www.ucdenver.edu/academics/colleges/medicalschool/programs/outcomes/childrensoutcomesresearch/vaccinepolicycollaborativeinitiative/pages/default.aspx.

23.

Crane

Daley

Barrow

Babbel

Stokley

Dickinson

, Sentinel physician networks as a technique for rapid immunization policy surveys. Eval Health Prof 2008;31:43–64.

24.

Hurley

Bridges

Harpaz

Allison

O'Leary

Crane

, U.S. physicians' perspective of adult vaccine delivery. Ann Intern Med 2014;160:161.

25.

Dillman

Internet, mail, and mixed-mode: Surveys, the tailored design method. 3rd ed. Hoboken (NJ): John Wiley & Sons, Inc.; 2009.

26.

Atkeson

Adams

Bryant

Zilberman

Saunders

. Considering mixed mode surveys for questions in political behavior: Using the Internet and mail to get quality data at reasonable costs. Political Behav 2011;33:161–78.

27.

McMahon

Iwamoto

Massoudi

Yusuf

Stevenson

David

, Comparison of e-mail, fax, and postal surveys of pediatricians. Pediatrics 2003;111(4 Pt 1):e299–303.

28.

SAS Institute, Inc. SAS®: Version 9.4 for Windows. Cary (NC): SAS Institute, Inc.; 2013.

29.

Cornuz

Ghali

Pecoud

Paccaud

Physicians' attitudes towards prevention: Importance of intervention-specific barriers and physicians' health habits. Fam Pract 2000;17:535–40.

30.

Hurley

Lindley

Harpaz

Stokley

Daley

Crane

, Barriers to the use of herpes zoster vaccine. Ann Intern Med 2010;152:555–60.

31.

Government Accountability Office (US). Many factors, including administrative challenges, affect access to Part D vaccinations [cited 2015 Feb 6]. Available from: http://www.gao.gov/products/GAO-12–61.

32.

O'Malley

Pham

Reschovsky

. Predictors of the growing influence of clinical practice guidelines. J Gen Intern Med 2007;22:742–8.

33.

Agency for Healthcare Research and Quality (US). National Quality Measures Clearinghouse [cited 2014 Oct 14]. Available from: http://www.qualitymeasures.ahrq.gov/index.aspx.

34.

Shenson

Adams

Bolen

Delivery of preventive services to adults aged 50–64: Monitoring performance using a composite measure, 1997–2004. J Gen Intern Med 2008;23:733–40.

35.

Shenson

Bolen

Adams

Receipt of preventive services by elders based on composite measures, 1997–2004. Am J Prev Med 2007;32:11–8.

36.

Centers for Disease Control and Prevention (US). CDC adult vaccine price list, 2015 [cited 2015 Feb 6]. Available from: http://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/#adult.

37.

Centers for Disease Control and Prevention (US). Prevention of pneumococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997;46(RR-8):1–24.

38.

Tomczyk

Bennett

Stoecker

Gierke

Moore

Whitney

, Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2014;63(37):822–5.

39.

Bennett

Whitney

Moore

Pilishvili

Dooling

. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012;61(40):816–9.

40.

Centers for Disease Control and Prevention (US). Pneumococcal ACIP vaccine recommendations. 2014 [cited 2015 Feb 6]. Available from: http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/pneumo.html.

41.

Centers for Disease Control and Prevention (US). Clinical decision support for immunization (CDSi), 2015 [cited 2015 Feb 6]. Available from: http://www.cdc.gov/vaccines/programs/iis/cds.html.

42.

Centers for Disease Control and Prevention (US). Adult immunization schedules, United States, 2015 [cited 2015 Feb 6]. Available from: http://www.cdc.gov/vaccines/schedules/hcp/adult.html#tool.

43.

Boulware

Marinopoulos

Phillips

Hwang

Maynor

Merenstein

, Systematic review: The value of the periodic health evaluation. Ann Intern Med 2007;146:289–300.

44.

Krogsboll

Jorgensen

Gronhoj

Gotzsche

. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012;345:e7191.

45.

Society of General Internal Medicine. Five things physicians and patients should question, 2013 [cited 2014 Oct 12]. Available from: http://www.choosingwisely.org/doctor-patient-lists/society-of-general-internal-medicine.

46.

American College of Physicians, Outland B. Accurate coding of the initial preventive physical examination [cited 2014 Oct 14]. Available from: www.acpinternist.org/archives/2014/10/coding.htm.