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Studying Physician Knowledge, Attitudes, and Practices Regarding the Herpes Zoster Vaccine to Address Perceived Barriers to Vaccination

Elkin, Zachary BA; Cohen, Elisabeth J. MD; Goldberg, Judith D. ScD; Gillespie, Colleen PhD; Li, Xiaochun PhD; Jung, Jesse MD; Cohen, Michael MD; Park, Lisa MD; Perskin, Michael H. MD

doi: 10.1097/ICO.0b013e318283453a
Clinical Science

Purpose: To increase usage of the herpes zoster (HZ) vaccine at an academic medical center by studying physicians' knowledge, attitudes, practices, and perceived barriers and analyze the findings by practice setting.

Methods: A cross-sectional Internet-based survey administered to all 266 general internal medicine physicians in 4 clinical settings at an academic medical center between October 6 and December 12, 2011. Outcomes measures included knowledge questions regarding the disease and vaccine recommendations, Likert-type items about physician attitudes and practices, and questions about barriers and proposed interventions to improve utilization.

Results: Response rate was 33.5% (89 of 266). Responders did not answer all questions. Only 66% (42 of 64) responded that HZ vaccination was an important clinical priority, and 48% (38 of 79) reported that less than 10% of their patients received the HZ vaccine. 95% responded that the influenza (61 of 64) and 92% that the pneumococcal (59 of 64) vaccines were important. Approximately 53% (42 of 79) and 51% (40 of 78) reported that more than 75% of their patients received these vaccines, respectively. Top barrier to vaccination was cost to patients (51 of 66; 77%). Lack of awareness of national recommendations (46 of 65, 71%) varied by setting. Physicians' preferred interventions included nurse-initiated prompting about vaccination (36 of 75, 48%) and chart reminders (34 of 74, 46%).

Conclusions: Not only increased knowledge but also a change in attitudes and practice are needed to enhance implementation of national recommendations. To improve use of this vaccine, physicians including ophthalmologists need to recommend it more strongly.

*Department of Ophthalmology, New York University School of Medicine, New York, NY

Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY

Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, NY.

Reprints: Elisabeth J. Cohen, Department of Ophthalmology, 33 East 70th St, Apt 6D, New York, NY 10021 (e-mail:

Supported, in part, by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. Also supported in part by grant UL1 TR000038 from the National Center for the Advancement of Translational Science (NCATS), National Institutes of Health.

The authors have no conflicts of interest to disclose.

Received October 18, 2012

Accepted December 14, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.