Why Don’t More Doctors Discuss Vaccines With Their Patients?
By Laura Landro
In the push to get Americans vaccinated against both the seasonal flu and the swine flu, infectious disease experts and public health officials are also sounding the alarm about continuing low rates of adult vaccination for a host of other preventable diseases, as I write in my latest column.
Despite evidence that vaccines are among the most cost-effective ways to prevent disease, studies show a pretty high level of ignorance on the part of patients — and a failure by many physicians to discuss vaccines with their patients, let alone administer the ones recommended by the CDC. “Often adults aren?t aware of vaccines, and if you ask them why they haven?t received a vaccine, they will say their doctor didn?t recommend it, so they didn?t ask for it,? Carol Freidman, associate director for adult immunizations at the CDC, tells the Health Blog.
For doctors, it often comes down to costs. In a survey by CDC?s vaccine advisory group, 85% of physicians said they believe reimbursement for immunization is inadequate, and a barrier to their practice. Many insurers don?t cover all adult vaccines, there is no national program to cover adult vaccinations for the underserved and Medicare?s coverage is spotty and complicated: Part B covers influenza, pneumoccocal and hepatitis B vaccines while Medicare Part D covers the zoster vaccine for shingles. Many doctors end up referring patients to public health clinics or retail clinics for vaccines, which may result in missed or delayed immunizations.
The National Vaccine Advisory Committee, which advises the federal government, is weighing some new recommendations to finance vaccines — such as a mandate to cover vaccines for all public and private health plans and a federal subsidy to pay for them. Freidman says an adult immunization advisory group is also looking at how to help doctors do a better job of immunizing their patients. Among the strategies that may work: mail or telephone reminders for patients to come in for needed shots, and awareness campaigns that educate healthier adults about their risks of passing disease on to vulnerable family members.
Electronic medical records could also help nudge doctors by popping reminders into patient?s charts and generating feedback about the percentage of a doctor?s patients who have been vaccinated or still need to be.
The push to get swine flu vaccines out to patients may prompt physicians to check their patients? medical records and get them up to speed on other vaccines they need, especially the pneumoccocal vaccine that can prevent the serious bacterial infections that are a primary cause of complications and death from the flu. ?The pneumococcal vaccine is seriously underutilized and we wish physicians would take the opportunity to recommend it now,? says William Schaffner, chair of the department of preventive medicine at Vanderbilt University and president-elect of the National Foundation for Infectious Diseases.
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