Dataset Information

Primary Care Physicians' Struggle with Current Adult Pneumococcal Vaccine Recommendations.

ABSTRACT: INTRODUCTION:In 2012, the Advisory Committee on Immunization Practices recommended 13-valent pneumococcal conjugate vaccine (PCV13) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for at-risk adults ?19; in 2014, it expanded this recommendation to adults ?65. Primary care physicians' practice, knowledge, attitudes, and beliefs regarding these recommendations are unknown. METHODS:Primary care physicians throughout the U.S. were surveyed by E-mail and post from December 2015 to January 2016. RESULTS:Response rate was 66% (617 of 935). Over 95% of respondents reported routinely assessing adults' vaccination status and recommending both vaccines. A majority found the current recommendations to be clear (50% "very clear," 38% "somewhat clear"). Twenty percent found the upfront cost of purchasing PCV13, lack of insurance coverage, inadequate reimbursement, and difficulty determining vaccination history to be "major barriers" to giving these vaccines. Knowledge of recommendations varied, with 83% identifying the PCV13 recommendation for adults ?65 and only 21% identifying the recommended interval between PCV13 and PPSV23 in an individual <65 at increased risk. CONCLUSIONS:Almost all surveyed physicians reported recommending both pneumococcal vaccines, but a disconnect seems to exist between perceived clarity and knowledge of the recommendations. Optimal implementation of these recommendations will require addressing knowledge gaps and reported barriers.

SUBMITTER: Hurley LP

PROVIDER: S-EPMC5774021 | biostudies-literature | 2018 Jan-Feb

REPOSITORIES: biostudies-literature

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Primary Care Physicians' Struggle with Current Adult Pneumococcal Vaccine Recommendations.

Hurley Laura P LP Allison Mandy A MA Pilishvili Tamara T O'Leary Sean T ST Crane Lori A LA Brtnikova Michaela M Beaty Brenda L BL Lindley Megan C MC Bridges Carolyn B CB Kempe Allison A

Journal of the American Board of Family Medicine : JABFM 20180101 1

<h4>Introduction</h4>In 2012, the Advisory Committee on Immunization Practices recommended 13-valent pneumococcal conjugate vaccine (PCV13) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for at-risk adults ≥19; in 2014, it expanded this recommendation to adults ≥65. Primary care physicians' practice, knowledge, attitudes, and beliefs regarding these recommendations are unknown.<h4>Methods</h4>Primary care physicians throughout the U.S. were surveyed by E-mail and post from ...[more]

PMID: 29330244

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Project description:IntroductionWe sought to develop evidence-based recommendations for the prehospital evaluation and treatment of adult and pediatric patients with a seizure and to compare these recommendations against the current protocol used by the 33 emergency medical services (EMS) agencies in California.MethodsWe performed a review of the evidence in the prehospital treatment of patients with a seizure, and then compared the seizure protocols of each of the 33 EMS agencies for consistency with these recommendations. We analyzed the type and route of medication administered, number of additional rescue doses permitted, and requirements for glucose testing prior to medication. The treatment for eclampsia and seizures in pediatric patients were analyzed separately.ResultsProtocols across EMS Agencies in California varied widely. We identified multiple drugs, dosages, routes of administration, re-dosing instructions, and requirement for blood glucose testing prior to medication delivery. Blood glucose testing prior to benzodiazepine administration is required by 61% (20/33) of agencies for adult patients and 76% (25/33) for pediatric patients. All agencies have protocols for giving intramuscular benzodiazepines and 76% (25/33) have protocols for intranasal benzodiazepines. Intramuscular midazolam dosages ranged from 2 to 10 mg per single adult dose, 2 to 8 mg per single pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intranasal midazolam dosages ranged from 2 to 10 mg per single adult or pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intravenous/intrasosseous midazolam dosages ranged from 1 to 6 mg per single adult dose, 1 to 5 mg per single pediatric dose, and 0.05 to 0.1 mg/kg as a weight-based dose. Eclampsia is specifically addressed by 85% (28/33) of agencies. Forty-two percent (14/33) have a protocol for administering magnesium sulfate, with intravenous dosages ranging from 2 to 6 mg, and 58% (19/33) allow benzodiazepines to be administered.ConclusionProtocols for a patient with a seizure, including eclampsia and febrile seizures, vary widely across California. These recommendations for the prehospital diagnosis and treatment of seizures may be useful for EMS medical directors tasked with creating and revising these protocols.

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Primary Care Physicians' Struggle with Current Adult Pneumococcal Vaccine Recommendations.

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Primary Care Physicians' Struggle with Current Adult Pneumococcal Vaccine Recommendations.

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