In a new study, researchers have found that almost all surveyed primary care physicians reported recommending both pneumococcal vaccines (PCV13 and PPSV23), but a disconnect seems to exist between perceived clarity and knowledge of the recommendations.

In the United States, Streptococcus pneumoniae bacteria causes an estimated 445,000 hospitalizations annually.1 In 2015 it caused approximately 29,500 cases of invasive pneumococcal disease and 3,350 deaths.

An adult pneumococcal disease is a major source of pneumococcal disease-related health care utilization and costs. Vaccines are an effective way to prevent pneumococcal disease and thereby reduce the burden and cost of pneumococcal disease.

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. Primary care physicians throughout the U.S. were surveyed by E-mail and post from December 2015 to January 2016.

The 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.

Almost all physicians reported assessing the need for, recommending, and stocking both pneumococcal vaccines and, if they did not stock pneumococcal vaccines, referring patients to receive them elsewhere.

While most physicians reported that the recommendations were clear, they identified several knowledge gaps regarding the recommendations. Physicians reported that prompts in the electronic medical record would help clarify the recommendations, and the majority reported not having them in place.

The top reported barriers to giving pneumococcal vaccines in series were financial concerns and difficulty determining a patient's pneumococcal vaccination history. Optimal implementation of these recommendations will require addressing knowledge gaps and reported barriers.