Is patient insurance type related to physician recommendation, administration and referral for adult vaccination? A survey of US physicians

Attitudes and practices to adult vaccination among physicians before and after COVID-19 pandemic in the United Arab Emirates

Introduction

Vaccination remains underutilised worldwide with low vaccine uptake rates across the board with many adults remaining unprotected. Across the Arab world, attitudes towards vaccines vary but high rates of vaccine hesitancy have been found. This study aims to explore the adult vaccination attitudes and practices by physicians in the UAE, both before and after the introduction of the COVID-19 vaccines.

Methodology

This cross-sectional, descriptive study used convenience and snowball sampling to collect comprehensive data from UAE physicians. A self-administered questionnaire was distributed in two stages: the first (pre-COVID-19 vaccines) between the months of June and October 2020 and the second between the months of November 2022 and March 2023.

Results

1000 responses, 500 from each time period, were collected. Nearly a third were family physicians or internists with more than 70% of the physicians working in governmental hospitals. 95% agreed that vaccines are safe in both cohorts but 74.4% reported not having enough time to advise about vaccines. 80.8% of physicians in the 2022 cohort reported safety concerns as the most common reason for patients to refuse vaccines. The most recommended vaccines were influenza (68.6%), Hepatitis B (66.0%) and HPV (61.4%), with pneumococcal coming in close at 57.8%. Family medicine physicians showed the highest utilisation of preventive practices across both cohorts. Nearly half of all family medicine physicians did not regularly evaluate both the influenza and general immunisation status of their patients. 54.6% of physicians reported having patients with VPDs in the last five years (not including COVID-19) in 2022.

Conclusion

Physicians have overly positive attitudes, but their practices reflect a more superficial appreciation of vaccines and lack of initiative. Physicians need to adopt a pro-vaccine stance, armed with the proper tools and the right mentality and beliefs.

Patient-centeredness-a cultural targeted survey among junior medical managers

BACKGROUND

Patient-centeredness is a core element in healthcare. However, there is a gap between the understanding of this term by healthcare professionals, and patients' capability, self-efficacy, and willingness to take part in medical decisions. We aim to expose standpoints toward "patient centeredness" among junior medical managers (JMM), as they bridge between policy strategies and patients. We try to reveal cultural differences by comparing the views of the majority and the minority subpopulations of Israel (Arabic and Hebrew speakers).

METHODS

A cross-sectional survey among JMM studying for an advanced degree in health-system management at three academic training colleges in Israel was conducted in February-March 2022. The respondents completed a structured questionnaire comprising four sections: a) perceptions of trust, accountability, insurance coverage, and economic status; b) perceptions regarding decision-making mechanisms; c) preferences toward achieving equity, and d) demographic details.

RESULTS

A total of 192 respondents were included in the study-50% Hebrew speakers and 50% Arabic speakers. No differences were found between Arabic and Hebrew speakers regarding perception of trust, accountability, insurance coverage, and economic status. JMM from both subpopulations believed that patients' gender and age do not influence physicians' attitudes but Arabic-speaking respondents perceived that healthcare professionals prefer educated patients or those with supportive families. All respondents believed that patients would like to be more involved in medical decisions; yet Arabic-speakers perceived patients as tending to rely on physicians' recommendations while Hebrew speakers believed that patients wish to lead the medical decision by themselves.

CONCLUSIONS

Patient-centeredness strategy needs to be implemented bottom-up as well as top-down, in a transparent nationwide manner. JMM are key actors in carrying out this strategy because they realize policy guidelines in the context of social disparities, enabling them to achieve a friendly personalized dialogue with their patients. We believe that empowering these JMM may create a ripple effect, yielding a bottom-up perception of equity and initiating change.

Costs of Specialist Referrals From Employer-Sponsored Integrated Health Care Clinics Are Lower Than Those From Community Providers

BACKGROUND

There have been very few published studies of referral management among commercially insured populations and none on referral management from employer-sponsored health centers.

OBJECTIVE

Describe the referral management system of an integrated employer-sponsored health care system and compare specialist referral rates and costs of specialist visits between those initiated from employer-sponsored health clinics and those initiated from community providers.

DESIGN

Retrospective, comparative cohort study using multivariate analysis of medical claims comparing care initiated in employer-sponsored health clinics with propensity-matched controls having specialist referrals initiated by community providers.

PATIENTS

Adult patients (≥ 18 years) eligible for employer-sponsored clinical services incurring medical claims for specialist referrals between 12/1/2018 and 12/31/2020. The study cohort was comprised of 3129 receiving more than 75% of their care in the employer-sponsored clinic matched to a cohort of 3129 patients receiving care in the community.

INTERVENTION

Specialist referral management program implemented by Crossover Health employer-sponsored clinics.

MAIN MEASURES

Rates and costs of specialist referrals.

KEY RESULTS

The relative rate of specialist referrals was 22% lower among patients receiving care in employers-sponsored health clinics (35.1%) than among patients receiving care in the community (45%, p <0.001). The total per-user per-month cost for patients in the study cohort was $372 (SD $894), compared to $401 (SD $947) for the community cohort, a difference of $29 (p<0.001) and a relative reduction of 7.2%. The lower costs can be attributed, in part, to lower specialist care costs ($63 (SD $140) vs $76 (SD $213) (p<0.001).

CONCLUSIONS

Employer-sponsored health clinics can provide effective integrated care and may be able to reduce avoidable specialist utilization. Standardized referral management and care navigation may drive lower specialist spend, when referrals are needed.

State-Level Variations and Factors Associated with Adult Vaccination Coverage: A Multilevel Modeling Approach

BACKGROUND

Adult vaccination rates in the USA are generally low and fall short of public health goals.

OBJECTIVES

Our aim was to evaluate the effect of state-level characteristics on adult vaccination coverage in the USA.

METHODS

This study was a cross-sectional, retrospective analysis of 2015-2017 Behavioral Risk Factor Surveillance System data, conducted from March to October 2019 and including seasonal influenza; pneumococcal; tetanus, diphtheria, and acellular pertussis (Tdap); and herpes zoster (HZ) vaccines. Multilevel logistic regression models examined interstate vaccination coverage variability and assessed the impact of state-level characteristics, with model-adjusted coverage estimated.

RESULTS

Model-adjusted vaccination coverage varied by state, with 35.1-48.1% coverage for influenza (2017), 68.2-80.8% for pneumococcal (2017), 21.9-46.5% for Tdap (2016), and 30.5-50.9% for HZ (2017). Characteristics associated with vaccination included state-level insurance coverage, pharmacists' vaccination authority, vaccination exemptions, and adult immunization information systems participation, as well as individual-level measures of income and education. After adjusting for these factors, substantial interstate heterogeneity remained.

CONCLUSIONS

Model-adjusted coverage was generally low and varied by state. A small number of state-level characteristics partially explained interstate coverage variability. This and future research assessing additional state characteristics may help determine policies most likely to increase adult vaccination.

Vaccinations and Chronic Diseases: Knowledge, Attitudes, and Self-Reported Adherence among Patients in Italy

The aims of this cross-sectional survey were to evaluate the knowledge, attitudes, and self-reported adherence to recommended vaccinations among a random sample of patients with chronic conditions presenting for a medical visit in out-patient clinics in Italy. Patients who were healthcare workers (HCWs), those with diabetes, those who had received information by Internet, physicians, and friends/relatives, and those who needed more information were more likely to know that the influenza vaccine is recommended for patients with chronic diseases. More than half (58.2%) and 8.9% self-reported to have received at least one recommended vaccination and more than one, respectively. Patients who believed that vaccine-preventable diseases (VPDs) were dangerous for them, those who had received information by physicians, and those who needed information were more likely to have received at least one recommended vaccination. This behavior was less likely in married patients, those who were worried about the side effects of the vaccines, and those who suffered from renal failure. The results highlight the need to implement effective vaccination programs in order to decrease the complication of VPDs in at-risk population.

State Policies on Access to Vaccination Services for Low-Income Adults

Importance

State vaccination benefits coverage and access for adult Medicaid beneficiaries vary substantially. Multiple studies have documented lower vaccination uptake in publicly insured adults compared with privately insured adults.

Objective

To evaluate adult Medicaid beneficiaries' access to adult immunization services through review of vaccination benefits coverage in Medicaid programs across the 50 states and the District of Columbia.

Design, Setting, and Participants

A public domain document review with supplemental semistructured telephone survey was conducted between June 1, 2018, and June 14, 2019, to evaluate vaccination services benefits in fee-for-service and managed care organization arrangements for adult Medicaid beneficiaries in the 50 states and the District of Columbia (total, 51 Medicaid programs).

Exposures

Document review of benefits coverage for adult immunization services and supplemental survey with validation of document review findings.

Main Outcomes and Measures

Benefits coverage for adult Medicaid beneficiaries and reimbursement amounts for vaccine purchase and administration.

Results

Public domain document review was completed for all 51 jurisdictions. Among these, 44 Medicaid programs (86%) validated document review findings and completed the survey. Only 22 Medicaid programs (43%) covered all 13 Advisory Committee on Immunization Practices-recommended adult immunizations under both fee-for-service and managed care organization arrangements. Most fee-for-service arrangements (37 of 49) reimbursed health care professionals using any of the 4 approved vaccine administration codes; however, 8 of 49 programs did not separately reimburse for vaccine administration to adult Medicaid beneficiaries. Depending on administration route, median reimbursement for adult vaccine administration ranged from $9.81 to $13.98 per dose. Median per-dose reimbursement for adult vaccine purchase was highest for 9-valent human papillomavirus vaccine ($204.87) and lowest for Haemophilus influenzae type b vaccine ($18.09). Median reimbursement was below the private sector price for 7 of the 13 included vaccines.

Conclusions and Relevance

Even in programs with complete vaccination benefits coverage, reimbursement amounts to health care professionals for vaccine purchase and administration may not fully cover vaccination provision costs. Reimbursement amounts below costs may reduce incentives for health care professionals to vaccinate low-income adults and thereby limit Medicaid adult beneficiary access to vaccination.

Healthcare Workers' Knowledge, Attitudes, and Practices about Vaccinations: A Cross-Sectional Study in Italy

The cross-sectional study assessed the knowledge, attitudes, and practices regarding the recommended vaccinations and factors affecting such outcomes among a sample of healthcare workers (HCWs) in public hospitals in Italy. Only 14.1% knew all the recommended vaccinations for HCWs. Physicians and those who had received information about vaccinations from scientific journals, educational activities, or professional associations were more likely to have this knowledge, while those aged 36–45 were more likely to have less knowledge than those in the age group below 36 years. Only 57.3% agreed that the information received about vaccinations was reliable. Respondents who had children, who worked in pediatric/neonatal wards, who were more knowledgeable, or who did not need further information about vaccinations considered the available information to be reliable. Only 17.7% of respondents always recommended vaccinations to their patients. This behavior was more likely to occur in physicians, in HCWs, in pediatric/neonatal wards, in those who considered the information received about vaccinations reliable, and in those who considered themselves to be at high risk of transmitting an infectious disease to their patients. Health promotion programs and efforts are needed to improve the level of knowledge about vaccinations and immunization coverage among HCWs.