What are some of the factors affecting whether pharmacies and physician offices stock adult vaccines?

A study in the American Journal of Managed Care sought to identify the most important reasons underlying those decisions.

University of Michigan School of Public Health–led researchers surveyed 125 U.S. physicians, nurses, pharmacists, and administrators of internal medicine, family medicine, obstetrics/gynecology, and multispecialty practices who were involved in vaccine-stocking decisions. Participants completed a best–worst scaling survey online between February and April 2018.

Researchers developed 16 potential factors influencing stocking decisions based on key informant interviews and focus groups. Respondents were asked to select factors that were most and least important in vaccine-stocking decisions, and the authors calculated relative importance scores for the best–worst scaling factors. Survey respondents described which vaccines their practice stocked and reasons for not stocking specific vaccines. 

In addition, subgroup analyses were performed based on the respondent’s involvement in vaccine decision making, role in the organization, specialty, and affiliation status, as well as practice characteristics such as practice size, insurance mix, and patient age mix.

Results indicate that relative importance scores for stocking vaccines were highest for “cost of purchasing vaccine stock,” “expense of maintaining vaccine inventory,” and “lack of adequate reimbursement for vaccine acquisition and administration.” 

While most respondents (97%) stocked influenza vaccines, stocking rates of other vaccines ranged from 39% (meningococcal B) to 83% (tetanus-diphtheria-pertussis). 

“Economic factors associated with the purchase and maintenance of vaccine inventory and inadequate reimbursement for vaccination services were the most important to decision makers when considering whether to stock or not stock vaccines for adults,” the authors conclude.

Prior research has shown that many providers do not stock adult vaccines, and this can be a barrier to patients receiving recommended vaccinations.

The researchers describe in what way vaccination rates in the U.S. are lower for adult vaccines although rates for children are high. They cite, for example, that the U.S. has achieved the Healthy People 2020 target of 30% for the shingles vaccine but not the adult influenza or pneumococcal immunization targets.

In terms of pneumococcal vaccination, the goals are 60% for high-risk adults aged 18 to 64 years and 90% for noninstitutionalized adults aged 65 years or older, but coverage rates are stuck at 24% and 67%, respectively, according to the report.

“Provider recommendations are a key predictor of adult vaccination; however, providers are less likely to recommend vaccines they do not stock,” the authors add, noting, “In the time since those studies were published, there have been changes in insurance reimbursement for vaccines with the Affordable Care Act, vaccination has expanded in pharmacies, and pharmacists are able to administer vaccines in all 50 states.”

That observation led the researchers to conduct the current study, which went beyond general internal medicine and family medicine physicians to survey physicians specializing in obstetrics and gynecology and multispecialty practices. 

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