U.S. clinicians' and pharmacists' reported barriers to implementation of the Standards for Adult Immunization Practice. Issue 45 (29th October 2018)

• Record Type: Journal Article
• Authors: Srivastav, Anup; Black, Carla L.; Lutz, Chelsea S.; Fiebelkorn, Amy Parker; Ball, Sarah W.; Devlin, Rebecca; Pabst, Laura J.; Williams, Walter W.; Kim, David K.
• Is Part Of: Vaccine. Volume 36:Issue 45(2018)
• Page Start: 6772
• Page End: 6781
• Publication Date: 2018-10-29
• Subjects: Standards Standards for Adult Immunization Practice -- IIS immunization information systems -- EHR electronic health records -- OB/GYN obstetricians/gynecologists; Clinician -- Pharmacist -- Standards for Adult Immunization Practice -- Vaccination implementation -- Adult vaccination -- Vaccination barriers; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2018.09.024
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Providers routinely assess, recommend, administer, and refer adults for vaccination. Only one third of clinicians and pharmacists routinely document adult vaccinations. Barriers to assess, recommend, administer, refer, document adult vaccines reported. Improving interoperability between electronic health records and registries needed. Abstract: Background: The Standards for Adult Immunization Practice (Standards), revised in 2014, emphasize that adult-care providers assess vaccination status of adult patients at every visit, recommend vaccination, administer needed vaccines or refer to a vaccinating provider, and document vaccinations administered in state/local immunization information systems (IIS). Providers report numerous systems- and provider-level barriers to vaccinating adults, such as billing, payment issues, lower prioritization of vaccines due to competing demands, and lack of information about the use and utility of IIS. Barriers to vaccination result in missed opportunities to vaccinate adults and contribute to low vaccination coverage. Clinicians' (physicians, physician assistants, nurse practitioners) and pharmacists' reported barriers to assessment, recommendation, administration, referral, and documentation, provider vaccination practices, and perceptions regarding their adult patients' attitudes toward vaccines were evaluated. Methods: Data from non-probability-based Internet panel surveys of U.S. clinicians (n = 1714) and pharmacists (n = 261) conducted in February-March 2017 were analyzed using SUDAAN. Weighted proportion of reported barriers to assessment, recommendation, administration, referral, and documentation in IIS were calculated. Results: High percentages (70.0%−97.4%) of clinicians and pharmacists reported they routinely assessed, recommended, administered, and/or referred adults for vaccination. Among those who administered vaccines, 31.6% clinicians' and 38.4% pharmacists' submitted records to IIS. Reported barriers included: (a) assessment barriers : vaccination of adults is not within their scope of practice, inadequate reimbursement for vaccinations; (b) administration barriers : lack of staff to manage/administer vaccines, absence of necessary vaccine storage and handling equipment and provisions; and (c) documentation barriers : unaware if state/city has IIS that includes adults or not sure how their electronic system would link to IIS. Conclusion: Although many clinicians and pharmacists reported implementing most of the individual components of the Standards, with the exception of IIS use, there are discrepancies in providers' reported actual practices and their beliefs/perceptions, and barriers to vaccinating adults remain.