RIO GRANDE, PUERTO RICO — A greater percentage of family physicians provided adult immunizations in 2008 compared with the previous year.
The cost of providing such immunizations, however, has surpassed the lack of demand among patients as the main barrier to family physicians providing such preventive care, according to 2008 results from the American Academy of Family Physicians National Immunization Survey.
At the same time, a greater proportion of family physicians referred patients elsewhere for immunizations, which suggests fragmentation of care, according to Dr. Herbert F. Young, director of scientific activities for the AAFP in Leawood, Kan.
Immunizations provide an opportunity for primary care providers to follow up on other preventive health measures, such as mammograms or chronic disease care, Dr. Young explained in an interview. “When patients are referred to public health clinics or other locations other than the patient-centered medical home, they may tend to return to them for subsequent immunizations and miss out on opportunities to get appropriate preventive care.”
Dr. Young added that he was surprised by the degree of variation around the country in terms of the role of the public health departments in providing immunizations. In some states such departments are a main source of immunization and in others they provide immunizations only to the neediest population.
Surveys were mailed in 2007 and again in 2008 to a randomly selected sample of 2000 AAFP members, including physicians from all 50 states and the District of Columbia, with a mix of urban, suburban, and rural practices, Dr. Young explained in an interview.
His poster findings were presented at the annual meeting of the North American Primary Care Research Group.
Responses were received from 882 physicians from the 2007 mailing and 708 physicians from the 2008 mailing. By practice type, 38% of respondents were from family medicine groups, 7% were from two-person partnerships, 23% were in solo practice, 17% were in multispecialty practices, 10% were from other practice settings. Data on practice type were unavailable on 6%.
The percentage of physicians providing flu vaccine to adults increased from 84% to 88%, and the provision of the HPV vaccine increased from 56% to 71%. The number of physicians who offered meningococcal vaccines to adults increased from 50% to 65%, and the number who offered zoster vaccines increased from 45% to 55%.
The percentage of physicians who said that they referred some of their adult patients elsewhere for vaccinations increased from 48% to 50%. The nature of the referrals changed slightly, however, with the percentage of physicians who referred patients to public health clinics for vaccinations decreasing from 72% in 2007 to 67% in 2008, and the percentage who referred patients to pharmacies increasing from 30% in 2007 to 32% in 2008.
Cost was the greatest barrier to immunization, reported by 63% and 72% of the physicians in 2007 and 2008, respectively. Other barriers reported in 2007 vs. 2008, respectively, were patients' personal and religious beliefs (34% vs. 40%), patient concerns about safety (34% vs. 47%), and complexity (23% vs. 21%).
In 2007, “lack of demand” was the most common reason physicians gave for not providing some adult vaccines (43%), but in 2008 “don't get payment to cover cost” had surpassed lack of demand as the most common reason (45%). Approximately a third of the physicians in both years reported that their patients had insurance, but it didn't cover vaccines.
The overall increase in vaccination rates is encouraging, said Dr. Barry L. Hainer, professor of family medicine at the Medical University of South Carolina, Charleston. There are steps physicians can take to ease the economic burden of vaccine delivery, he added. Buyers' cooperatives such as the Kelson Pediatric Partners' Vaccine Purchasing Program and the Children's Practicing Pediatricians, for example, allow smaller practices to obtain group discounts on childhood and adult vaccines.
The key is to have someone on staff who is familiar with coverage policies for all the major insurers so that patients can be charged their portion of the cost at the time of administration, he said.
Requiring an out-of-pocket fee may not amount to much if the vaccine is $10 a dose. But there is serious money at stake for a vaccine such as Zostavax, he said in an interview.
The study was limited by the use of self-reports, which may differ from actual practice, the researchers noted.
The study was supported in part by the Centers for Disease Control and Prevention, and the authors had no personal financial conflicts to disclose.
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