Laura P. Hurley, MD, MPH; Megan C. Lindley, MPH; Rafael Harpaz, MD, MPH; Shannon Stokley, MPH; Matthew F. Daley, MD; Lori A. Crane, PhD, MPH; Fran Dong, MS; Brenda L. Beaty, MSPH; Litjen Tan, PhD, MS; Christine Babbel, MSPH; L. Miriam Dickinson, PhD; Allison Kempe, MD, MPH
Acknowledgment: The authors thank Laura Seewald, BA, for aiding in the preparation of the manuscript. They also thank all pediatricians and family medicine physicians in the networks for participating and responding to the survey.
Grant Support: By the CDC (CDC SIP 5 U48 DP000054-03).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-2541.
Reproducible Research Statement:Study protocol: Available from Dr. Hurley (address below). Statistical code and data set: Certain portions of the analytic data set are available to approved individuals through written agreements with Dr. Hurley and the Centers for Disease Control and Prevention.
Requests for Single Reprints: Laura P. Hurley, MD, MPH, Wellington Webb Center for Primary Care, Denver Health, 301 West 6th Avenue, MC 3251, Denver, CO 80204.
Current Author Addresses: Dr. Hurley: Wellington Webb Center for Primary Care, Denver Health, 301 West 6th Avenue, MC 3251, Denver, CO 80204.
Ms. Lindley and Ms. Stokley: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-52, Atlanta, GA 30333.
Dr. Harpaz: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-47, Atlanta, GA 30333.
Dr. Daley: Institute for Health Research Kaiser Permanente—Colorado, 10065 East Harvard Avenue, #300, Denver, CO 80231.
Dr. Crane: Colorado School of Public Health, 13001 East 17th Place, B119, Building 500, Room E3343a, Aurora, CO 80045.
Ms. Dong, Ms. Beaty, and Drs. Dickinson and Kempe: Colorado Health Outcomes Research Program, 12477 East 19th Avenue, F443, Aurora, CO 80045.
Dr. Tan: American Medical Association, 515 North State Street, Chicago, IL 60610-4320.
Ms. Babbel: Children's Outcomes Research Program, 12477 East 19th Avenue, F443, Aurora, CO 80045.
Author Contributions: Conception and design: L.P. Hurley, M.C. Lindley, R. Harpaz, S. Stokley, M.F. Daley, L.A. Crane, L. Tan, C. Babbel, A. Kempe.
Analysis and interpretation of the data: L.P. Hurley, M.C. Lindley, R. Harpaz, M.F. Daley, L.A. Crane, F. Dong, B.L. Beaty, L. Tan, C. Babbel, L.M. Dickinson, A. Kempe.
Drafting of the article: L.P. Hurley, A. Kempe.
Critical revision of the article for important intellectual content: M.C. Lindley, R. Harpaz, S. Stokley, M.F. Daley, L.A. Crane, L. Tan, C. Babbel, A. Kempe.
Final approval of the article: M.C. Lindley, R. Harpaz, S. Stokley, M.F. Daley, L.A. Crane, B.L. Beaty, L. Tan, A. Kempe.
Statistical expertise: F. Dong, B.L. Beaty, L.M. Dickinson.
Obtaining of funding: L.A. Crane, A. Kempe.
Administrative, technical, or logistic support: R. Harpaz, C. Babbel, A. Kempe.
Collection and assembly of data: L.A. Crane, C. Babbel, A. Kempe.
Hurley LP, Lindley MC, Harpaz R, Stokley S, Daley MF, Crane LA, et al. Barriers to the Use of Herpes Zoster Vaccine. Ann Intern Med. 2010;152:555-560. doi: 10.7326/0003-4819-152-9-201005040-00005
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Published: Ann Intern Med. 2010;152(9):555-560.
The herpes zoster vaccine is the most expensive vaccine recommended for older adults and the first vaccine to be reimbursed through Medicare Part D. Early uptake has been 2% to 7% nationally.
To assess current vaccination practices, knowledge and practice regarding reimbursement, and barriers to vaccination among general internists and family medicine physicians.
Mail and Internet-based survey, designed through an iterative process and conceptually based on the Health Belief Model.
National survey conducted from July to September 2008.
General internists and family medicine physicians.
Survey responses on current vaccination practices, knowledge and practice regarding reimbursement, and barriers to vaccination.
Response rates were 72% in both specialties (301 general internists and 297 family medicine physicians). Physicians in both specialties reported similar methods for delivering vaccine, which included stocking and administering the vaccine in their offices (49%), referring patients to a pharmacy to purchase the vaccine and bring it back to the office for administration (36%), and referring patients to a pharmacy for vaccine administration (33%). Eighty-eight percent of providers recommend herpes zoster vaccine and 41% strongly recommend it, compared with more than 90% who strongly recommend influenza and pneumococcal vaccines. For physicians in both specialties, the most frequently reported barriers to vaccination were financial. Only 45% of respondents knew that herpes zoster vaccine is reimbursed through Medicare Part D. Of respondents who began administering herpes zoster vaccine in their office, 12% stopped because of cost and reimbursement issues.
Survey results represent reported but not observed practice. Surveyed providers may not be representative of all providers.
Physicians are making efforts to provide herpes zoster vaccine but are hampered by barriers, particularly financial ones. Efforts to facilitate the financing of herpes zoster vaccine could help increase its use.
Centers for Disease Control and Prevention.
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Infectious Disease, Vaccines/Immunization, Prevention/Screening.
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