September 24, 2013
Each year, vaccine preventable diseases impact the lives of millions of people in the United States. While there have been tremendous gains in vaccinating and preventing infectious diseases in children under the age of 18, due in part to the establishment of the Vaccines for Children Program in 1994, the complexity of reaching adults in need of recommended vaccinations often varies by age group, risk factors, existing medical conditions and medical insurance coverage.
Last year, the California Medical Association Foundation’s Network of Ethnic Physician Organizations (NEPO), in collaboration with the Immunization Coalition of Los Angeles County and the Los Angeles County Department of Public Health Immunization Program, launched a web-based survey of physicians affiliated with public and private clinics. The goal of the survey was to assess community capacity to vaccinate adults as recommended by the Advisory Committee on Immunization Practices, the federal organization responsible for written immunization guidelines across the lifespan.
Adult immunization coverage rates remain low in Los Angeles County, a geographic region well known for its vibrant culturally and economically diverse communities. To date, there is limited information on the availability of vaccines and the immunization practices of local health care providers who serve adult populations. This survey was an attempt to understand the issues affecting adult vaccine service delivery within the county.
According to the survey results, commonly stocked vaccines for adults varied by medical specialty, which is consistent with larger studies of adult immunization providers. The survey results highlighted that physicians within family medicine and internal medicine specialties were more likely to report stocking adult vaccines compared to obstetrics/gynecology physicians. According to the survey results, vaccines that prevent influenza, hepatitis B, pertussis and tetanus were most commonly reported to be in stock within the respondents’ medical practices. Vaccines that prevent meningitis and shingles were the least stocked and known to be the most expensive of all the adult vaccines. A majority of physicians also reported stocking and recommending vaccines to prevent pneumonia among high risk adults (18 years and older) as well as among healthy adults age 50 years and older. Lack of adequate reimbursement for vaccine-related costs; patient concerns about vaccine safety; and inability to determine a patient’s vaccine history were the most common reasons providers gave for not stocking/offering adult immunizations, but the reasons given varied across provider type.
Within medical practices with low or limited availability of vaccines, adults are being referred to other locations such as public health centers and pharmacies. A reliance on these alternative immunization sites may result in missed opportunities to vaccinate due to the enforcement of specific eligibility requirements and/or high out-of-pocket costs. Adult vaccine service delivery could be improved through the use of evidence-based strategies, such as the California Immunization Registry to remind and recall patients when vaccines are due. While many physicians reported the use of some type of remind/recall strategy, immunization registry use was underutilized by respondents in the survey.
While this small scale survey is based on self-reported data, the results concurred with the findings from other larger studies and warrant further exploration to build on these preliminary efforts.