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

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Abstract
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. 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. National survey of general internists representative of the American College of Physicians. 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. 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.

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