Physician Practices Regarding Adult Hepatitis B Vaccination: A National Survey
published online 13 April 2009.
Background
Less than 50% of adults with risk factors for hepatitis B infection have been vaccinated. Although primary care settings typically serve an important role in immunization delivery, little is known about adult hepatitis B vaccination practices in primary care, including the use of strategies such as standing orders to improve immunization rates. The objectives of this study were to assess, among family physicians and general internists, current approaches to assessing adult patients for hepatitis B risk factors, reported hepatitis B vaccination practices, and attitudes about standing orders for hepatitis B vaccination.
Methods
From September to November 2006, a national sample of 433 family physicians and 420 general internists were surveyed. Results were analyzed in 2007 and 2008.
Results
Response rates were 65% for family physicians and 79% for general internists. Thirty-one percent of physicians reported assessing most or all adult patients for hepatitis B risk factors and vaccinating patients identified as high risk. Perceived barriers to hepatitis B vaccination included patients not disclosing high-risk behaviors, lack of adequate reimbursement for vaccination, and feeling too pressed for time to assess risk factors. Most surveyed physicians were very (47%) or somewhat (38%) supportive of using standing orders for hepatitis B vaccination in their practices. However, staff time constraints and patient unwillingness to disclose sensitive information to staff were perceived as barriers to using standing orders by a majority of respondents.
Conclusions
In a national survey, less than one third of primary care physicians reported routinely assessing for and vaccinating adults with hepatitis B risk factors. This finding suggests that new strategies for adult hepatitis B vaccination in primary care settings are needed. Most physicians supported using standing orders for vaccination, but barriers were anticipated.
aDepartment of Pediatrics, University of Colorado Denver, Denver, Colorado
bDepartment of Internal Medicine, University of Colorado Denver, Denver, Colorado
cDepartment of Family Medicine, University of Colorado Denver, Denver, Colorado
dColorado Health Outcomes Program, University of Colorado Denver, Denver, Colorado
eDivision of General Internal Medicine, Denver Health and Hospitals, Denver, Colorado
fChildren's Outcomes Research Program, The Children's Hospital, Colorado School of Public Health, Aurora, Colorado
gDepartment of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
hDivision of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
iImmunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Address correspondence and reprint requests to: Matthew F. Daley, MD, Mailstop F443, 12477 E. 19th Avenue, Aurora CO 80045-0508
ABSTRACT