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Findings from Recent Consumer and Health-Care Provider Surveys

Adelphi Research by Design

supported by sanofi pasteur

David R. Johnson, MD, MPH NVAC MeetingDirector, Scientific & Medical Affairs October 22, 2007sanofi pasteur Washington DC

Barriers to Adult Immunization

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Objectives, Focus, MethodologiesUndertaken to provide assessment of reasons US adults do not get recommended vaccines & to inform efforts to increase rates

Focus on influenza, pneumococcal & Td vaccines

Structured telephone interviews during Sept & Oct 2006

2002 consumersConsumers selected using Random Digit Dialing samplingData weighted to approximate US population characteristics

200 health-care providers (HCP)100 primary care physicians33 physician assistants, 33 nurse practitioners, and 34 registered nursesRecruited through a national database

Sampling errorTotal consumer sample: ±2.2% [95% CI]Health-care provider sample: ±9.8% [95% CI]

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Key Finding: Provider Recommendations Are a Critical Factor in Consumer Decisions

80% of consumers are likely to follow a health-care provider’s recommendation to get a vaccine; unfortunately, most consumers never talk to their HCP about vaccines

Percent who are aware of the vaccine, but have never talked to their HCP about:

Pneumococcal vaccine by target population:≥65 years of age (56%)Chronic illness or condition (45%)

Tetanus vaccine (69%)Influenza vaccine (61%)

Among the listed reasons consumers do not get vaccinations, “My doctor has not told me I need it” is cited often:

Pneumococcal (53%)Tetanus (51%)Influenza (39%)

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Key Finding: HCPs and Consumers Have Different Perspectives on Why People Forego Vaccination

0

10

20

30

40

50

60

70

Influenza Pneumococcal Tetanus

Percent Citing Side Effects

1316

4

64

38 37

Consumers

Health-care Providers

Vaccine

Consumers: What are the main reasons you might not get a (vaccine name) as recommended?

HCPs: What are the main reasons that might prevent the adult patients in your practice from getting each vaccine as recommended?

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Reasons Consumers Forego Vaccination: Tetanus, Aided Responses*

0 10 20 30 40 50 60 70 80

Costs too much

Insurance does not cover

Dislike needles

May have side effects

Do not visit doctor regularly

Do not know when to get it

Doctor has not told me I need it

Healthy, do not need it

Only need it when injured

Yes, that is a reason (%)

*Would you say [REASON] is a reason you have not received a tetanus vaccine as recommended?

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Key Finding: Consumers Lack Awareness About Adult Vaccines

At best, fewer than half of consumers believe they will need a particular vaccine in the future:

Influenza (46%)Pneumococcal (19%)30% do not know or do not believe they will need any vaccinations in the future

Consumers are unaware of vaccine recommendationsWhich adults need an influenza vaccine?

Seniors, elderly, and adults ≥65years of age (44%)All adults (31%)Adults ≥50 years of age (7%)

51% do not believe all adults need a tetanus vaccination

Substantial numbers of consumers do not believe they are at risk of getting ill if they are not vaccinated

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Key Finding: There Are Gaps in HCP Knowledge and Practices

Immunization schedules are issued annually by the CDC*, based on input and guidance from a 15-member expert panel (ACIP†)

40-44% of HCPs do not make use of these resources

Mild to moderate illnesses, even with fever, do not contraindicate vaccination

26-30% believe sick patients should not be vaccinated, regardless of severity of illness

All adults ≥50 years of age should get an influenza vaccine annually

72% MDs, 85% NP, PA, and RN do not correctly identify people in this age group as recommended for annual vaccination

A tetanus booster is recommended every 10 years for adults19% MD, 21% NP, PA, and RN are not aware of or do not believe a booster is necessary every 10 years

*CDC=Centers for Disease Control and Prevention;†ACIP=Advisory Committee for Immunization Practices

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Key Finding: Lack of Regular Well-care Visits is a Barrier to Vaccination

24% of consumers have not had a well-care visit >12 months;

likelihood varies by gender, age, health:Men (33%) vs. women (17%)

Age: 19-34 years (30%) and 35-44 years (32%) versus ≥65 years (11%)

Excellent or very good health (27%) versus good, fair, or poor health (21%)

Well-care Visit (%) Acute-care Visit (%)

MD 73 29

PA, NP, and RN 77 42

Likelihood of HCPs Discussing & Recommending Vaccines by Visit Type*

*HCP self-report

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Key Finding: Cost Is Not a Major Barrier to Adult Immunization

Vaccine Unaided* (ranking) Aided† (ranking)

Influenza 7% (5) 18% (10)

Pneumococcal 3% (6) 14% (11)

Tetanus 7% (6) 17% (9)

Consumers Citing Cost as a Barrier, by Vaccine

*What are the main reasons you might not get a(n) influenza, pneumococcal, or tetanus vaccine?

†Would you say (cost) is a reason you have not received a(n) influenza, pneumococcal, or tetanus vaccine?

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Consumer Sub-population Differences by Insurance Status

Consumers citing cost as a barrier to vaccination

Unaided (%) Aided (%)

Insured Uninsured Insured Uninsured

Tetanus 4 17 10 38

Influenza 3 18 13 34

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Summary: Survey Indicates Main Consumer Barriers Relate to Knowledge

Major barriers includeLack of health-care provider recommendations

Lack of consumer, and even health-care provider, knowledge about vaccines

Absence of well-care visits for many consumers

Cost appears to be a less important barrier,

even among those most sensitive to itVariations in cost sensitivity seen among those with lower incomes and no insurance

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Strategies to Increase Immunization Rates

Increase awareness Large percentage of consumers, and even health-care providers, are unaware of immunization schedules and recommendations

Increase knowledgeVaccines are safe and effective

Vaccine-preventable diseases (VPD) are serious

Encourage health-care providers to routinize adult

immunizationHealth-care provider recommendations will have a strong, positive effect on patient vaccination decisions

Health-care providers are best situated to dispel consumer fears and misconceptions about vaccines and VPDs

Expand first-dollar insurance coverageSupport increased private sector vaccination coverage as part of routine care