Every year, 30,000 people on average die of vaccine preventable illnesses but what is most surprising about this statistic is that nearly all — 95 percent — are adults. Now a new study from the University of Colorado School of Medicine investigates this growing concern and identifies barriers to the delivery of adult vaccines: the failure of health care providers to assess the vaccination needs of their patients, insufficient stock of vaccines, inadequate insurance reimbursement, record-keeping challenges, and high costs. "As the population ages this could easily grow into a more serious public health issue," said Dr. Laura Hurley, lead author of the study and an assistant professor of medicine at the CU School of Medicine.

Avoiding Preventable Deaths

The Advisory Committee on Immunization Practices recommends 12 vaccines for adults, yet recent estimates suggest that only 62 percent and 65 percent of adults over the age of 65 received even a pneumococcal or flu vaccine, respectively. Worse, only 16 percent of adults over the age of 60 received a herpes zoster vaccine, which prevents shingles, a painful viral infection most common in people older than 50. Why do vaccination rates remain low among adults who are at serious risk for preventable disease?

To answer this question, researchers conducted a survey in collaboration with the Centers for Disease Control and Prevention of general internists (GIMs) and family physicians (FMs) from March to June 2012 throughout the U.S. Response rates were high, a full 79 percent of GIMs and 62 percent of FMs completed nearly all of their surveys, and so the total number of participants amounted to 607. A minority used immunization information systems and nearly half — 46 percent of GIMs and 48 percent of FMs — reported it was “moderately/very difficult” to determine an adult patient's vaccination status for vaccines other than seasonal influenza.

Almost all the doctors reported assessing patients’ vaccination status at annual visits or first visits, whereas far fewer reported doing so at every visit: just 29 percent of general internists and 32 percent of family physicians.

"Our study suggests that missed opportunities for adult vaccination are common because vaccination status is not being assessed at every (physician's) visit, which is admittedly an ambitious goal," Hurley stated in a press release. "Also, most physicians are not stocking all recommended vaccines." Physicians reported a number of barriers to stocking and administering vaccines, but money dominated the list. In fact, lack of insurance coverage for the vaccine (36 percent) or inadequate reimbursement (41 percent) were the most commonly reported reasons for referring patients elsewhere, such as pharmacies/retail stores and public health departments.

Noting that “primary care physicians see themselves as having a central role in the system,” the authors conclude their study with various observations as well as suggestions for improvement that center on addressing doctor's direct needs and concerns. The Affordable Care Act requires insurers to cover recommended vaccines with no co-pays when delivered by in-network providers; this should topple one financial barrier to vaccination, the authors suggest. And then there is the Immunization Information Systems or IIS, which is a confidential database that records all vaccine doses administered by providers in a given area. Widespread and consistent use of IIS would allow doctors to check the vaccination status of their patients in a glance. "I feel we need to take a more systematic approach to this issue," Hurley concluded. Surely, deaths caused by vaccine-preventable illnesses might be easily avoided.

Source: Hurley LP, Bridges CB, Harpaz R, Allison MA, O’Leary ST, Crane LA, et al. U.S. Physicians’ Perspective of Adult Vaccine Delivery. Annals of Internal Medicine. 2014.