Improving Adherence to National Recommendations for Zoster Vaccination Through Simple Interventions

Abstract

Background In 2011, 15.8% of eligible patients in the US were vaccinated against herpes zoster (HZ). Purpose To increase usage of the HZ vaccine by studying physicians’ knowledge, attitudes, practices, and perceived obstacles after interventions to overcome barriers. Methods General internal medicine (GIM) physicians were surveyed with a cross-sectional internet survey October to December 2011 before interventions to increase use of the HZ vaccine and 1 year later. Interventions included education, increasing availability at the medical center pharmacy, and electronic medical record reminders. Outcome measures included changes in knowledge, attitudes, and practices, and perceived barriers. McNemar chi square tests were used to compare the changes from the baseline survey for physicians who completed the follow up survey. Results Response rate for the baseline study was 33.5% (89/266) and for the follow-up 29.8% (75/252). 55 completed both surveys. There was a decrease from 57% at baseline to 40% at follow-up in the proportion of physicians who reported less than 10% of their patients were vaccinated. They were more likely to know the HZ annual incidence (30% baseline; 70% follow-up; p=0.02), and report having educational information for physicians (7% baseline; 27% follow-up; p=0.003). The top helpful intervention was nursing administration of the vaccine. Average monthly HZ vaccine usage in the affiliated outpatient pharmacy increased in the 10 months between surveys by 156% compared with the 3 months prior to the baseline survey. Conclusions Interventions implemented during the study led to an increase in physicians’ basic knowledge of the HZ vaccine and an increase in usage at the affiliated pharmacy.

Herpes Zoster Vaccination: Controversies and Common Clinical Questions

“…A study from the Netherlands of prospective candidates for the vaccine found that even when cost was removed as a limiting factor, major barriers to vaccination remained including perceived lack of recommendation by the provider and the perception of low risk for HZ [35]. Interventions including provider education, use of clinical reminders in the electronic medical record, increasing on-site availability and nursing administration of the vaccine have been shown to increase vaccine usage [36]. …”

Persistent dilemmas in zoster eye disease

“…Despite interventions to overcome these barriers, including education, availability at pharmacies and electronic medical record reminders, primary-care doctors do not consider this vaccine as important as influenza and pneumonia vaccines 42 43. Ophthalmologists can also recommend this vaccine to their patients 41.…”

Herpes ZosterVaccine to the Homebound Elderly: Prevention, Protection, and Access to Care

“…One of the main causes of low immunizations rates is attributed to the lack of provider recommendation, albeit time constraints, knowledge deficits, or personal beliefs. 16 The National Vaccine Advisory Committee recommends registering vaccinations in individual state's Immunization Information Systems (IIS) to document and track immunizations 17 as a means to improve awareness and knowledge of required adult immunizations.…”

“…9 In 2015, approximately 69% of the Medicare enrollees signed up for Medicare Part D. 8 Clinicians were not able to administer the vaccine at the clinical appointment due to reimbursement concerns, hampering the ability to offer certain vaccinations. 16 In 2014, the cost for Zostavax® in the United States ranged from $123 to $253. 20 could produce a fee of up to $32 for the clinician.…”

“…9 Nevertheless, this arduous method has been recognized as one of the barriers to vaccination. 16 Homebound populations have often been unable to procure the vaccine in this manner. Additionally, the homebound population tends to be elderly with multiple comorbidities.…”