U.S. Physicians’ Perspective of Adult Vaccine Delivery

Annals of Internal Medicine
4 February 2014, Vol. 160. No. 3

U.S. Physicians’ Perspective of Adult Vaccine Delivery
Laura P. Hurley, MD, MPH; Carolyn B. Bridges, MD; Rafael Harpaz, MD, MPH; Mandy A. Allison, MD, MSPH; Sean T. O’Leary, MD; Lori A. Crane, PhD, MPH; Michaela Brtnikova, PhD; Shannon Stokley, MPH; Brenda L. Beaty, MSPH; Andrea Jimenez-Zambrano, MPH; Faruque Ahmed, PhD; Craig Hales, MD, MPH; and Allison Kempe, MD, MPH


Background: Adults are at substantial risk for vaccine-preventable disease, but their vaccination rates remain low.

Objective: To assess practices for assessing vaccination status and stocking recommended vaccines, barriers to vaccination, characteristics associated with reporting financial barriers to delivering vaccines, and practices regarding vaccination by alternate vaccinators.

Design: Mail and Internet-based survey.

Setting: Survey conducted from March to June 2012.

Participants: General internists and family physicians throughout the United States.

Measurements: A financial barriers scale was created. Multivariable linear modeling for each specialty was performed to assess associations between a financial barrier score and physician and practice characteristics.

Results: Response rates were 79% (352 of 443) for general internists and 62% (255 of 409) for family physicians. Twenty-nine percent of general internists and 32% of family physicians reported assessing vaccination status at every visit. A minority used immunization information systems (8% and 36%, respectively). Almost all respondents reported assessing need for and stocking seasonal influenza; pneumococcal; tetanus and diphtheria; and tetanus, diphtheria, and acellular pertussis vaccines. However, fewer assessed and stocked other recommended vaccines. The most commonly reported barriers were financial. Characteristics significantly associated with reporting greater financial barriers included private practice setting, fewer than 5 providers in the practice, and, for general internists only, having more patients with Medicare Part D. The most commonly reported reasons for referring patients elsewhere included lack of insurance coverage for the vaccine (55% for general internists and 62% for family physicians) or inadequate reimbursement (36% and 41%, respectively). Patients were most often referred to pharmacies/retail stores and public health departments.

Limitations: Surveyed physicians may not be representative of all physicians.

Conclusion: Improving adult vaccination delivery will require increased use of evidence-based methods for vaccination delivery and concerted efforts to resolve financial barriers, especially for smaller practices and for general internists who see more patients with Medicare Part D.

Primary Funding Source: Centers for Disease Control and Prevention.

Editors’ Notes


Vaccination rates in adults are low, even though more than 95% of Americans who die of vaccine-preventable disease each year are adults. General internists and family medicine physicians were surveyed about vaccine perceptions and practices.


Barriers related to vaccine delivery included lack of regular assessment of vaccine status, insufficient stocking of some vaccines, and financial disincentives for vaccination in the primary care setting. Use of electronic tools to record and prompt vaccination was low. Most physicians surveyed accepted vaccination outside of the medical home but believed communication between themselves and alternate vaccinators was suboptimal.


System changes are necessary to improve adult vaccination in the United States.