# Presentation: 040715

## Barriers to Adult Immunization

**Findings from Recent Consumer and Health-Care Provider Surveys**
**Adelphi Research by Design**
**supported by sanofi pasteur**
**David R. Johnson, MD, MPH****	****	****	****NVAC Meeting**
**Director, Scientific & Medical Affairs****	****	****October 22, 2007**
**sanofi pasteur ****	****	****	****	****	****Washington DC**

**Barriers to Adult Immunization**

## Objectives, Focus, Methodologies

**Undertaken to provide assessment of reasons US adults do not get recommended vaccines & to inform efforts to increase rates**
**Focus on influenza, pneumococcal & Td vaccines**
**Structured telephone interviews during Sept & Oct 2006**
**2002 consumers**
**Consumers selected using Random Digit Dialing sampling**
**Data weighted to approximate US population characteristics**
**200 health-care providers (HCP)**
**100 primary care physicians**
**33 physician assistants, 33 nurse practitioners, and 34 registered nurses**
**Recruited through a national database**
**Sampling error**
**Total consumer sample: ±2.2% [95% CI]**
**Health-care provider sample: ±9.8% [95% CI]**

## Key Finding: Provider Recommendations Are a Critical Factor in Consumer Decisions

**80% of consumers are likely to follow a health-care provider’s recommendation to get a vaccine; unfortunately, most consumers never talk to their HCP about vaccines**
**Percent who are aware of the vaccine, but have never talked to their HCP about:**
- Pneumococcal vaccine by target population:
- ≥65 years of age (56%)
- Chronic illness or condition (45%)
- Tetanus vaccine (69%)
- Influenza vaccine (61%)
**Among the listed reasons consumers do not get vaccinations, “My doctor has not told me I need it” is cited often:**
**Pneumococcal (53%)**
**Tetanus (51%)**
**Influenza (39%)**

## Key Finding: HCPs and Consumers Have Different Perspectives on Why People Forego Vaccination

**Percent Citing Side Effects**

**13**

**16**

**4**

**64**

**38**

**37**

- Consumers

- Health-care Providers

**Vaccine**

*Consumers: What are the main reasons you might not get a (vaccine name) as recommended?*
*HCPs: What are the main reasons that might prevent the adult patients in your practice from getting each vaccine as recommended?*

## Reasons Consumers Forego Vaccination: Tetanus, Aided Responses*

**Yes, that is a reason (%)**

**Would you say [REASON] is a reason you have not received a tetanus vaccine as recommended?*

## Key Finding: Consumers Lack Awareness About Adult Vaccines

**At best, fewer than half of consumers believe they will need a particular vaccine in the future:**
**Influenza (46%)**
**Pneumococcal (19%)**
**30% do not know or do not believe they will need *****any***** vaccinations in the future**
**Consumers are unaware of vaccine recommendations**
**Which adults need an influenza vaccine?**
- Seniors, elderly, and adults ≥65years of age (44%)
- All adults (31%)
- Adults ≥50 years of age (7%)
**51% do not believe all adults need a tetanus vaccination**
**Substantial numbers of consumers do not believe they are at risk of getting ill if they are not vaccinated**

## Key Finding: There Are Gaps in HCP Knowledge and Practices

**Immunization schedules are issued annually by the CDC*********, based on input and guidance from a 15-member expert panel (ACIP****†****)**
**40-44% of HCPs do not make use of these resources**
**Mild to moderate illnesses, even with fever, do not contraindicate vaccination**
**26-30% believe sick patients should not be vaccinated, regardless of severity of illness**
**All adults ≥50 years of age should get an influenza vaccine annually**
**72% MDs, 85% NP, PA, and RN do not correctly identify people in this age group as recommended for annual vaccination**** **
**A tetanus booster is recommended every 10 years for adults**
**19% MD, 21% NP, PA, and RN are not aware of or do not believe a booster is necessary every 10 years**

- *CDC=Centers for Disease Control and Prevention;
- †ACIP=Advisory Committee for Immunization Practices

## Key Finding: Lack of Regular Well-care Visits is a Barrier to Vaccination

**24% of consumers have not had a well-care visit >12 months; likelihood varies by gender, age, health:**
**Men (33%) vs. women (17%)**
**Age: 19-34 years (30%) and 35-44 years (32%) versus ≥65 years (11%)**
**Excellent or very good health (27%) versus good, fair, or poor health (21%)**

|  | Well-care Visit (%) | Acute-care Visit (%) |
| --- | --- | --- |
| MD | 73 | 29 |
| PA, NP, and RN | 77 | 42 |

**Likelihood of HCPs Discussing & Recommending Vaccines by Visit Type***

- *HCP self-report

## Key Finding: Cost Is Not a Major Barrier to Adult Immunization

| Vaccine | Unaided* (ranking) | Aided† (ranking) |
| --- | --- | --- |
| Influenza | 7% (5) | 18% (10) |
| Pneumococcal | 3% (6) | 14% (11) |
| Tetanus | 7% (6) | 17% (9) |

**Consumers Citing Cost as a Barrier, by Vaccine**

- *What are the main reasons you might not get a(n) influenza, pneumococcal, or tetanus vaccine?
- †Would you say (cost) is a reason you have not received a(n) influenza, pneumococcal, or tetanus vaccine?

## Consumer Sub-population Differences by Insurance Status

**Consumers citing cost as a barrier to vaccination**

|  | Unaided (%) |  | Aided (%) |  |
| --- | --- | --- | --- | --- |
|  | Insured | Uninsured | Insured | Uninsured |
| Tetanus | 4 | 17 | 10 | 38 |
| Influenza | 3 | 18 | 13 | 34 |

## Summary: Survey Indicates Main Consumer Barriers Relate to Knowledge

**Major barriers include**
**Lack of health-care provider recommendations**
**Lack of consumer, and even health-care provider, knowledge about vaccines**
**Absence of well-care visits for many consumers**
**Cost appears to be a less important barrier, even among those most sensitive to it**
**Variations in cost sensitivity seen among those with lower incomes and no insurance**

## Strategies to Increase Immunization Rates

**Increase awareness **
**Large percentage of consumers, and even health-care providers, are unaware of immunization schedules and recommendations**
**Increase knowledge**
**Vaccines are safe and effective**
**Vaccine-preventable diseases (VPD) are serious **
**Encourage health-care providers to routinize adult immunization**
**Health-care provider recommendations will have a strong, positive effect on patient vaccination decisions**
**Health-care providers are best situated to dispel consumer fears and misconceptions about vaccines and VPDs**
**Expand first-dollar insurance coverage**
**Support increased private sector vaccination coverage as part of routine care**