Is patient insurance type related to physician recommendation, administration and referral for adult vaccination? A survey of US physicians
Is patient insurance type related to physician recommendation, administration and referral for adult vaccination? A survey of US physicians
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DOI：
10.1080/21645515.2019.1582402
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发表时间：
2019-03-21
影响因子：
4.8
通讯作者：
Hogea, Cosmina
中科院分区：
文献类型：
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作者：
McNamara, Michelle;Buck, Philip O.;Hogea, Cosmina
本研究评价了美国（US）成人流感、破伤风、白喉、百日咳（Tdap）和带状疱疹疫苗接种的医生实践和感知障碍，重点是医疗保险与商业保险患者。2017年5月，对从美国全国医生小组招募的经委员会认证的全科/家庭医生和内科医生（N = 1，000）进行了一项基于互联网的横断面调查。对于流感，无论保险类型如何，医生推荐率（84%的医疗保险患者，82%的商业保险患者），管理率（80%的医疗保险，78%的商业）和转诊率（11%的医疗保险，11%的商业）都是相似的。与医疗保险患者相比，商业患者的Tdap推荐更高（59%对54%，p < 0.001）;而医疗保险患者的带状疱疹推荐高于商业患者（59%对55%，p < 0.001）。对于Tdap和带状疱疹，商业患者（64% Tdap，36%带状疱疹）的给药率高于医疗保险（56% Tdap，32%带状疱疹），医疗保险患者（19% Tdap，49%带状疱疹）的转诊率高于商业患者（14% Tdap，42%带状疱疹）。超过40%的医生将更有可能管理Tdap和带状疱疹疫苗，如果他们被涵盖在医疗保险B部分，与更多的医生表示，财政障碍为“重大”或“中度”的医疗保险比商业病人。这些差异可能与医疗保险D部分所涵盖的成人疫苗接种相关的财务障碍有关，并涉及患者自付费用。努力减少医疗保险D部分所涵盖的成人疫苗接种相关的财务障碍，并提高患者和医生的知识，可能会对美国成人疫苗接种的医生推荐、管理和转诊产生积极影响。
This study evaluated physician practices and perceived barriers for influenza, tetanus, diphtheria, pertussis (Tdap), and zoster vaccination of adults in the United States (US), with emphasis on patients with Medicare versus commercial insurance. A cross-sectional internet-based survey of board-certified general/family practitioners and internists (N = 1,000) recruited from a national US physician panel was conducted in May 2017. For influenza, rates of physician recommendation (84% of Medicare patients, 82% of commercially-insured patients), administration (80% Medicare, 78% commercial), and referral (11% Medicare, 11% commercial) were similar regardless of insurance type. Tdap recommendation was higher for commercial compared to Medicare patients (59% vs. 54%, p < 0.001); while zoster recommendation was higher for Medicare patients than commercial (59% vs. 55%, p < 0.001). For Tdap and zoster, higher administration rates were reported in commercial patients (64% Tdap, 36% zoster) than Medicare (56% Tdap, 32% zoster), and referral rates were higher for Medicare patients (19% Tdap, 49% zoster) than commercial (14% Tdap, 42% zoster). Over 40% of physicians would be much more likely to administer Tdap and zoster vaccines if they were covered under Medicare Part B, with more physicians indicating financial barriers as "major" or "moderate" for Medicare than commercial patients. These differences may be related to financial barriers associated with adult vaccinations that are covered under Medicare Part D and involve patient out-of-pocket costs. Efforts to reduce financial barriers associated with adult vaccinations covered under Medicare Part D and to improve patient and physician knowledge could positively impact physician recommendation, administration, and referral for adult vaccination in the US.