BALTIMORE — The type of insurance coverage that an adult has impacts how they are vaccinated, according to research presented at the National Foundation for Infectious Diseases’ Annual Conference on Vaccinology Research.
Researchers found that most patients with commercial insurance or a Medicare supplemental plan are vaccinated during “well visits” with primary care physicians, whereas most patients on Medicaid receive their vaccines during “non-well” visits, often from providers listed in insurance claims databases as “other” or “unknown,” indicating a lack of preventive care visits for these patients, explained Sara Poston, PharmD, director of health outcomes insights for vaccines at GlaxoSmithKline.
Poston and colleagues also identified what they called “gaps in vaccination delivery” that could be addressed to improve adult vaccination rates.
“While the Affordable Care Act increased access to preventive care services, including vaccines, vaccine uptake in adults remains suboptimal. Adult immunizations are a critical — and underutilized tool to improve health and reduce health care costs,” Poston told Infectious Disease News. “Our study aimed to provide a snapshot of the adult vaccine landscape between 2011 and 2016 to assess where gaps and opportunities exist to improve adult vaccination.”
Poston and colleagues used data from the Truven MarketScan Commercial Claims, Medicare Supplemental, and Medicaid Multi-State databases between 2011 and 2016 to analyze characteristics of influenza, Tdap, pneumococcal and herpes zoster (HZ) vaccination in adults aged 19 or older and identify potential opportunities for vaccination after implementation of the Affordable Care Act.
According to the study, they defined potential missed opportunities for vaccination as preventive care visits at which patients were eligible for vaccination but did not receive one, and missed encounters as patients who had no preventive care visits during the observation period.
Results showed that most patients with commercial insurance or Medicare received influenza (56.74%), Tdap (51.87%) and HZ (66.78%) vaccinations at preventive care visits, most often from family and internal medicine providers, whereas a large proportion of vaccinations in the Medicaid group occurred during nonpreventive care visits.
“A consistent trend of increasing vaccinations in the pharmacy setting and decreasing vaccinations in the outpatient setting was also observed across vaccines and payers over time,” they wrote.
Additionally, Poston and colleagues found that among patients with commercial insurance or Medicare, 53.20% of the HZ vaccination-eligible cohort and 36.40% of the pneumococcal vaccination-eligible cohort experienced missed opportunities for vaccination, whereas 69.58% of the influenza vaccination-eligible cohort had missed encounters in at least one influenza season. Among the Medicaid sample, researchers determined that many patients had missed encounters in the continuously enrolled influenza (84.57%), HZ (61.68%) and pneumococcal vaccine-eligible cohorts (50.83%).
“Critical opportunities exist in practice to improve adult vaccination rates across the board; patient interactions with the health care system via different types of health care professionals need to be better leveraged to ensure adherence to recommended vaccinations,” Poston concluded. “This could be achieved by enhanced education of providers and patients about the importance of adult vaccines, robust reminder-recall systems and the use of adult quality metrics to improve utilization and reporting.” – by Caitlyn Stulpin
Aris E, et al. Abstract 204. Presented at: NFID Annual Conference on Vaccinology Research; April. 3-5, 2019; Baltimore.
Disclosures: The author report no relevant financial disclosures.