Barriers to Complete Adult Immunization in Vermont

Introduction: Rates of adult immunization in Vermont are below the Vermont Immunization Program Goal Tracker targets. As complete immunization would significantly decrease morbidity and mortality from infectious disease, UVM COM students sought to determine and understand barriers to complete immunization from the perspective of relevant primary care physicians in Vermont. Objective: Assist the Vermont Department of Health (VDH) with future policy initiatives to improve rates of adult immunization. Methods: An electronic survey was emailed to 572 internal medicine and family medicine doctors across Vermont. The survey included 26 questions to assess current knowledge, behavior, and perceptions toward adult immunization. Results: Data from 88 respondents (15.4% response rate) showed that most physicians adhered to and agreed with current CDC recommendations. The top practice-related barrier to complete immunization was lack of patient reminder system, followed by lack of provider time. The top patient-related barriers included lack of patient-perceived need, patient concern about immunization safety, cost to patient, and uncertainty regarding immunization history, respectively. Regarding potentially beneficial interventions, respondents stated that use of an electronic reminder system, as well as a state-wide immunization registry, would be helpful. Conclusions: Provider access to information regarding immunization guidelines is adequate. Specific barriers, both practice-related and patient-related, seem to play significant roles in impeding complete adult immunization. More education is needed in older adults regarding the effectiveness of and need for adult immunizations. Improvements in electronic tracking have the potential to increase adult immunization rates. This approach could be used in other geographic locations.