Abstract
Background
Pneumococcal vaccine (PPV) is recommended for adults ≥65 years and those with chronic illness, but there are potential advantages of universal vaccination of adults age 50–64 years.
Objective
To assess reported (1) recommendations and administration practices of general internists for PPV, (2) barriers to vaccination, and (3) willingness to expand vaccination to all adults ≥50 years.
Methods
National survey of general internists representative of the American College of Physicians.
Results
Response rate was 74% (N = 326). Although 99% reported giving PPV, less than 20% used a computerized database to identify eligible patients by age or diagnoses and only 6% recalled patients. Major barriers included acute problems taking precedence over preventive care (39%), difficulty determining vaccination history (30%), not thinking of it/not a priority (20%), and inadequate reimbursement for vaccine (19%). If ACIP expanded recommendations, 60% would definitely and 37% would probably institute this change.
Conclusions
Most general internists reported giving PPV, but delivery was hindered by competing demands, lack of systems to identify patients needing vaccination, and reimbursement issues. Barriers might be decreased by a policy of universal vaccination of adults ≥50 years, and the majority of physicians reported they would follow such a recommendation if it were made.
This is a preview of subscription content, log in via an institution to check access.
References
Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs) Report Emerging Infections Program Network. Streptococcus pneumoniae, 2005. Available at: http://www.cdc.gov/ncidod/dbmd/abcs/survreports/spneu05.pdf. Last accessed: September 2008.
Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997;46:1–24.
Centers for Disease Control and Prevention. Recommendations and Guidelines: Adult Immunization Schedule. Available at: http://www.cdc.gov/mmwr/pdf/wk/mm5641-Immunization.pdf. Last accessed: September 2008.
Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination coverage among persons aged ≥65 years–United States, 2004–2005. MMWR Morb Mortal Wkly Rep. 2006;55:1065–8.
Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination coverage among persons aged ≥65 years and persons aged 18–64 years with diabetes or asthma–United States, 2003. MMWR Morb Mortal Wkly Rep.. 2004;53:1007–12.
Greene CM, Kyaw MH, Ray SM, et al. Preventability of invasive pneumococcal disease and assessment of current polysaccharide vaccine recommendations for adults: United States, 2001–2003. Clin Infect Dis. 2006;43:141–150.
Gardner P. A need to update and revise the pneumococcal vaccine recommendations for adults. Ann Intern Med. 2003;138:999–1000.
Sisk JE, Whang W, Butler JC, Sneller VP, Whitney CG. Cost-effectiveness of vaccination against invasive pneumococcal disease among people 50 through 64 years of age: role of comorbid conditions and race. Ann Intern Med. 2003;138:960–8.
Sisk JE, Riegelman RK. Cost effectiveness of vaccination against pneumococcal pneumonia: an update. Ann Intern Med. 1986;104:79–86.
Crane LA, Daley MF, Barrow J, et al. Sentinel physician networks as a technique for rapid immunization policy surveys. Eval Health Prof. 2008;31:43–64.
Janz NK, Champion VL, Strecher VJ. The health belief model. In: Glanz K, Rimer BK, Lewis FM, eds. Health behavior and health education: theory, research, and practice. San Francisco, CA: Jossey-Bass; 2002:45–66.
Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley and Sons, Inc; 1989.
Szilagyi PG, Bordley C, Vann JC, et al. Effect of patient reminder/recall interventions on immunization rates: A review. JAMA. 2000;284:1820–1827.
Conaty S, Watson L, Dinnes J, Waugh N. The effectiveness of pneumococcal polysaccharide vaccines in adults: a systematic review of observational studies and comparison with results from randomised controlled trials. Vaccine. 2004;22:3214–24.
Moberley SA, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2008;CD000422.
Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med. 2004;164:2206–16.
Fedson DS. Adult immunization. Summary of the National Vaccine Advisory Committee Report. JAMA. 1994;272:1133–7.
Ndiaye SM, Hopkins DP, Shefer AM, et al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. Am J Prev Med. 2005;28:248–79.
Dexter PR, Perkins SM, Maharry KS, Jones K, McDonald CJ. Inpatient computer-based standing orders vs physician reminders to increase influenza and pneumococcal vaccination rates: a randomized trial. JAMA. 2004;292:2366–71.
Acknowledgements
This investigation was funded by the Centers for Disease Control and Prevention SIP 5 U48 DP000054–03. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, US Department of Health and Human Services. This funding was obtained and administered through the Rocky Mountain Prevention Research Center, University of Colorado Denver. The authors have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(DOC 118 KB)
Rights and permissions
About this article
Cite this article
Kempe, A., Hurley, L., Stokley, S. et al. Pneumococcal Vaccination in General Internal Medicine Practice: Current Practice and Future Possibilities. J GEN INTERN MED 23, 2010–2013 (2008). https://doi.org/10.1007/s11606-008-0800-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-008-0800-0