October 2007 NVAC Meeting Minutes
Some priorities for adult vaccination coverage assessments include keeping the NHIS and the BRFSS current with new vaccines for adults, periodically assessing the validity of self-reporting vaccines other than influenza, promoting State use of the BRFSS, and evaluating MDS data for monitoring influenza and pneumococcal vaccines in long-term care facilities.
Dr. Lovell commented that one would expect the nursing home population to have 100 percent influenza vaccination coverage. Mr. Singleton stated that the main limitation with adult vaccination coverage surveys was respondents’ ability to recall what vaccines they had received. He went on to note that the NHIS becomes expensive when additional questions are added. Dr. Schuchat said that the BRFSS is not just an immunization survey but is used by States for general health planning.
Ms. Trish Parnell expressed concern that there was not much information on college-age individuals. Mr. Singleton stated that some organizations such as the American College Health Association conduct surveys but that that it is very expensive to conduct stand-alone surveys. College students are missed or are not identified in NHIS and BRFSS.
Attitudes About and Barriers to Adult Vaccination—Dr. Faruque Ahmed
Dr. Ahmed began by providing information on studies undertaken to determine why patients do not seek vaccination. For example, the MCBS asked patients why they did not get the pneumococcal vaccine. Some of the most common responses were that patients did not know the vaccine was needed, the patient’s provider did not recommend the vaccine, and they did not think about vaccinations at all. Another survey, conducted in 2001, asked patients why they did not receive the influenza vaccine. A common response was that patients were concerned about the vaccine’s side effects. Others were not offered the vaccine by their provider. Some thought the vaccine was not effective, and others were not aware that they needed the vaccine.
Dr. Ahmed reported on the differences among Whites, Blacks, and Hispanics in terms of their awareness of specific vaccines and the primary reasons for not being vaccinated. He observed that racial disparities can be reduced by systematically offering vaccinations. The most common reasons patients are not vaccinated is because of concerns about the vaccine, misconceptions about the vaccine, a lack of awareness that the vaccine is needed, mistrust, and specific cultural/ethnic issues.
Physicians identified the following barriers to offering vaccines: Urgent concerns that dominate the visit, not knowing the patient’s immunization history, the patient’s concerns about the safety of the vaccine, and inadequate reimbursement.
Dr. Ahmed went on to discuss some evidence-based interventions for increasing adult immunization rates. These include provider and patient reminders, standing orders for adult immunizations, and reducing out-of-pocket costs for immunizations.
Dr. Ahmed also discussed a study that focused on whether an increase in payment would encourage providers to adopt new adult immunization strategies. Providers are more likely to discuss immunization needs if they have time, if the information is available, and if they have the operational support to do so.
Studies have shown that individuals with no regular personal healthcare provider had lower influenza vaccination rates than those with a regular personal healthcare provider. More Hispanics than non-Hispanics reported not having a regular personal healthcare provider. Studies have also shown that individuals with health insurance were more likely to get the influenza vaccine than those without health