Pneumococcal Vaccination in General Internal Medicine Practice: Current Practice and Future Possibilities

BACKGROUND: Pneumococcal vaccine (PPV) is recommended for adults >= 65 years and those with chronic illness, but there are potential advantages of universal vaccination of adults age 50-64 years. OBJECTIVE: To assess reported (1) recommendations and administration practices of general internists for PPV, (2) barriers to vaccination, and (3) willingness to expand vaccination to all adults >= 50 years. METHODS: National survey of general internists representative of the American College of Physicians. RESULTS: Response rate was 74% (N = 326). Although 99% reported giving PPV, less than 20% used a computerized database to identify eligible patients by age or diagnoses and only 6% recalled patients. Major barriers included acute problems taking precedence over preventive care (39%), difficulty determining vaccination history (30%), not thinking of it/not a priority (20%), and inadequate reimbursement for vaccine (19%). If ACIP expanded recommendations, 60% would definitely and 37% would probably institute this change. CONCLUSIONS: Most general internists reported giving PPV, but delivery was hindered by competing demands, lack of systems to identify patients needing vaccination, and reimbursement issues. Barriers might be decreased by a policy of universal vaccination of adults >= 50 years, and the majority of physicians reported they would follow such a recommendation if it were made.