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.
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Article info
Publication history
Published online: April 13, 2009
Identification
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© 2009 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
