Primary Care Physicians' Perspectives On Stocking Adult Vaccines

Background: Several new vaccines have been recommended for adults over the past few years. Although pediatricians have long been accustomed to stocking many different vaccines, historically the same has not been true for those physicians who provide primary care to adults. Currently, little is known regarding the immunization purchase and stocking practices of these physicians.

Objectives: To document the proportion of primary care physicians for adults (family practice and internal medicine physicians) who routinely stock specific adult vaccines and their rationale for those decisions.

Methods: In the spring of 2009, we conducted a mailed survey of a national random sample of family practice and internal medicine physicians in office-based primary care. Frequencies and bivariate analyses were conducted using SAS.

Results: The overall response rate was 59% (N=1106). Of those responding, 77% indicated that their practice regularly stocks at least one vaccine for adults aged 19-64 years. The proportion of practices that did not stock specific vaccines for adults ranged from 8% to 55%. The most commonly stocked vaccines were Td and PPSV23. The least commonly stocked vaccine was zoster (45% stocked). The reasons for not stocking varied slightly by specific vaccines, but on average the most commonly chosen were “high inventory cost” (37%) and “patients receive elsewhere” (30%). Of the choices provided as reasons for not stocking specific vaccines, only one was selected by more than 50% of respondents; the high inventory cost of zoster vaccine. Differences by specialty and by decision-making status related to vaccines also were explored.

Conclusions: Many primary care physicians who provide care to adults do not stock recommended immunizations. Efforts to improve adult immunization rates must address this fundamental issue. The ability of such primary care providers to function as a medical home for their patients is severely compromised if these providers can not, or will not, deliver this major component of preventive medicine.