Is patient insurance type related to physician recommendation, administration and referral for adult vaccination? A survey of US physicians

Abstract

This study evaluated physician practices and perceived barriers for influenza, tetanus, diphtheria, pertussis (Tdap), and zoster vaccination of adults in the United States (US), with emphasis on patients with Medicare versus commercial insurance. A cross-sectional internet-based survey of board-certified general/family practitioners and internists (N = 1,000) recruited from a national US physician panel was conducted in May 2017. For influenza, rates of physician recommendation (84% of Medicare patients, 82% of commercially-insured patients), administration (80% Medicare, 78% commercial), and referral (11% Medicare, 11% commercial) were similar regardless of insurance type. Tdap recommendation was higher for commercial compared to Medicare patients (59% vs. 54%, p < 0.001); while zoster recommendation was higher for Medicare patients than commercial (59% vs. 55%, p < 0.001). For Tdap and zoster, higher administration rates were reported in commercial patients (64% Tdap, 36% zoster) than Medicare (56% Tdap, 32% zoster), and referral rates were higher for Medicare patients (19% Tdap, 49% zoster) than commercial (14% Tdap, 42% zoster). Over 40% of physicians would be much more likely to administer Tdap and zoster vaccines if they were covered under Medicare Part B, with more physicians indicating financial barriers as "major" or "moderate" for Medicare than commercial patients. These differences may be related to financial barriers associated with adult vaccinations that are covered under Medicare Part D and involve patient out-of-pocket costs. Efforts to reduce financial barriers associated with adult vaccinations covered under Medicare Part D and to improve patient and physician knowledge could positively impact physician recommendation, administration, and referral for adult vaccination in the US.

Keywords: Adult vaccines; Tdap; influenza; physician preferences; vaccine recommendations; zoster.

Figure 1.

(a) Annual physical/well visits by adult patients, (b) Barriers to adult patients receiving vaccinations. FPs: family practice physicians; GPs: general practitioners; IMs: internal medicine physicians; Total number of Physicians = 1,000

Figure 2.

Criteria physicians use to determine patient eligibility for various vaccines. Note: ‘Other’ criteria not shown (Influenza 0.7%; Tdap 0.9%; Zoster 0.4%); Total number of Physicians = 1,000; Tdap, tetanus/diphtheria/acellular pertussis vaccine

Figure 3.

(a) Eligible patients recommended vaccine by insurance type, (b) Eligible patients administered/referred to vaccine by insurance type. Tdap, tetanus/diphtheria/acellular pertussis vaccine; Total number of Physicians = 1,000

Figure 4.

Barriers as identified by physicians to (a) Influenza, (b) Tdap and (c) Zoster vaccinations. Tdap, tetanus/diphtheria/acellular pertussis vaccine; Total number of Physicians = 1,000. Note: Sums of percentages may not equal 100% due to rounding.

Figure 5.

Willingness to administer Tdap and zoster vaccines if covered under Medicare Part B instead of Medicare Part D. Tdap, tetanus/diphtheria/acellular pertussis vaccine; Total number of Physicians = 1,000

Figure 6.

Focus on the patient.

Figure 7.

Survey design. FPs: family practice physicians; GPs: general practitioners; IMs: internal medicine physicians; NE: northeast; MW: midwest; S: south; W: west.