Why Adults Aren't Getting Vaccinated

Adult immunizations continue to be low in part because of costs

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Most people probably associate vaccination with kids getting their shots at regular doctor visits. But adults need to stay up to date with their immunizations too.

In fact, there are 12 vaccines recommended for adults, but many adults go without these vaccinations. Some of these adults then die from vaccine-preventable diseases such as pneumonia or the flu.

A recent study found that one contributing factor to these low vaccination rates includes the practices and financial barriers at the offices of family doctors.

"Ask your doctor about the CDC recommended immunization schedule."

This study, led by Laura P. Hurley, MD, MPH, of Denver Health in Colorado, looked at what obstacles exist in ensuring adults are up to date on their vaccinations.

The researchers conducted a survey from March through June 2012 with 352 general internists and 255 family doctors.

The survey results revealed that less than a third of these doctors assessed patients' vaccination status at each visit to the doctor.

Only 29 percent of general internists and 32 percent of family doctors did so.

While approximately 36 percent of family doctors used immunization information systems, only 8 percent of general internists did.

The good news was that nearly all the doctors filling out the survey said they regularly determine whether they need and then appropriately stock several common vaccines.

These vaccines included those for the seasonal flu, pneumococcal disease, tetanus-diphtheria (Td) and tetanus-diphtheria-pertussis (Tdap).

Other vaccines besides these, however, were less commonly assessed and stocked on a regular basis, primarily due to financial logistics at the practices, the doctors reported.

For example, the shingles (herpes zoster) vaccine is recommended for patients aged 60 and older, even though only about 16 percent of adults in this age range had gotten the shot in a recent study.

The shingles shot is among those that the physicians reported they did not necessarily assess and stock on a regular basis.

The doctors reporting financial burdens related to stocking vaccines were more likely to be in private practices with fewer than five providers at the practice, compared to those with fewer financial obstacles.

The general internists who had higher proportions of patients using Medicare Part D health plans were also more likely to report financial barriers to stocking other vaccines.

The questionnaire also asked doctors for what reasons they most commonly sent patients elsewhere to get a vaccine.

Just over half (55 percent of internists and 62 percent of family doctors) said such referrals occurred when patients' insurance didn't cover the vaccine.

Similarly, 36 percent of internists and 41 percent of family doctors reported that not getting adequately reimbursed by health plans for the vaccines led them to refer patients elsewhere.

These patients were most commonly referred to pharmacies, retail stores and public health departments.

The authors concluded that one of the ways to address low vaccination rates among adults is to address the financial barriers that doctors experience.

"The findings from this study are not particularly surprising," said Adam Powell, PhD, a health economist and President of Payer+Provider Syndicate.

"Vaccines are perishable and must be carefully stored," he said. "It goes without saying that a practice with a smaller volume patients will dispense a given type of vaccine less frequently."

Dr. Powell added that it's also costly to buy a vaccine inventory.

"Larger practices are less likely to have inventory spoil than smaller practices due to the higher volumes that they experience," he said.

This study was published February 4 in the Annals of Internal Medicine. The research was funded by the US Centers for Disease Control and Prevention (CDC). The authors reported no conflicts of interest.

Review Date: 
February 13, 2014
Last Updated:
February 23, 2014