title: Pneumococcal vaccination in general internal medicine practice: current practice and future possibilities.
abstract: BACKGROUND
  Pneumococcal vaccine (PPV) is recommended for adults >or=65 years and those with chronic illness, but there are potential advantages of universal vaccination of adults age 50-64 years.
  
  
  OBJECTIVE
  To assess reported (1) recommendations and administration practices of general internists for PPV, (2) barriers to vaccination, and (3) willingness to expand vaccination to all adults >or=50 years.
  
  
  METHODS
  National survey of general internists representative of the American College of Physicians.
  
  
  RESULTS
  Response rate was 74% (N = 326). Although 99% reported giving PPV, less than 20% used a computerized database to identify eligible patients by age or diagnoses and only 6% recalled patients. Major barriers included acute problems taking precedence over preventive care (39%), difficulty determining vaccination history (30%), not thinking of it/not a priority (20%), and inadequate reimbursement for vaccine (19%). If ACIP expanded recommendations, 60% would definitely and 37% would probably institute this change.
  
  
  CONCLUSIONS
  Most general internists reported giving PPV, but delivery was hindered by competing demands, lack of systems to identify patients needing vaccination, and reimbursement issues. Barriers might be decreased by a policy of universal vaccination of adults >or=50 years, and the majority of physicians reported they would follow such a recommendation if it were made.
authors.affiliation: Department of Pediatrics, University of Colorado Denver, Denver, CO, USA. Kempe.allison@tchden.org
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.forename: Laura
authors.initials: L
authors.lastname: Hurley
authors.forename: Shannon
authors.initials: S
authors.lastname: Stokley
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Beaty
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: Christine
authors.initials: C
authors.lastname: Babbel
authors.forename: Jennifer
authors.initials: J
authors.lastname: Barrow
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D003625:Data Collection / Q000379:methods / Q000639:trends; D005194:Family Practice / Q000379:methods / Q000592:standards / Q000639:trends*; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards / Q000639:trends*; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic / Q000592:standards; D014611:Vaccination / Q000379:methods / Q000639:trends*
chemical_list: D022242:Pneumococcal Vaccines