Primary Care Physicians' Struggle with Current Adult Pneumococcal Vaccine Recommendations

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d938530e217">Introduction</h5> <p id="P1">In 2012, ACIP recommended 13-valent pneumococcal conjugate vaccine (PCV13) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults ≥19 at risk, and, in 2014, expanded this recommendation to adults ≥65. Primary care physicians’ practice, knowledge, attitudes and beliefs regarding these recommendations are unknown. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d938530e222">Methods</h5> <p id="P2">General internists (GIM) and family physicians (FP) throughout the U.S. were surveyed by email and mail from December 2015 to January 2016. Multivariable analysis examined characteristics associated with knowledge of the recommendations (January 2016-September 2016). </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d938530e227">Results</h5> <p id="P3">Response rate was 66% (617/935). Over 95% reported routinely assessing adults’ vaccination status and recommending both vaccines. A majority found the current recommendations to be clear (50% ‘very clear’, 38% ‘somewhat clear’). Twenty percent found the upfront cost of purchasing PCV13, lack of insurance coverage, inadequate reimbursement and difficulty determining vaccination history to be ‘major barriers’ to giving these vaccines in series. Knowledge of recommendations was variable with 83% identifying the PCV13 recommendation for adults ≥65 and only 21% identifying the recommended interval between PCV13 and PPSV23 in an individual &lt;65 at increased risk. Characteristics associated with greater knowledge included GIM vs. FP specialty (adjusted RR=1.45; 95% CI 1.09–1.88), younger vs. older age (adjusted RR=1.41; 95% CI 1.04–1.88), and perceiving the recommendations to be ‘very clear’ vs. other perceptions (adjusted RR=1.50; 95% CI=1.15–1.96). </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d938530e232">Conclusions</h5> <p id="P4">Almost all surveyed physicians reported recommending both pneumococcal vaccines, but there appears to be a disconnect between perceived clarity and knowledge of the recommendations. Optimal implementation of these recommendations will require addressing knowledge gaps and reported barriers. </p> </div>