Physicians may miss flu vaccination opportunities for Medicare patients

Only 50.5% of Medicare beneficiaries ages 19 or older had received an influenza vaccine during the 2018 to 2019 flu season, and vaccination rates were significantly higher among White beneficiaries than Black or Hispanic beneficiaries.

Clinicians may be missing opportunities to vaccinate Medicare patients against influenza, and racial disparities exist in vaccination rates, a study found.

Researchers from the CDC studied 31.6 million U.S. adults continuously enrolled in Medicare Parts A and B during the 2018 to 2019 influenza season. They defined missed vaccination as the proportion of beneficiaries who had documented evaluation and management (E/M) services during the flu season but no influenza vaccination claim. Results were published online Nov. 15 by Annals of Internal Medicine.

Half (50.5%) of Medicare beneficiaries ages 19 or older received an influenza vaccine during the 2018 to 2019 flu season. Among this group, 31.6% were ages 19 to 64 years old and 54% were ages 65 years or older. Individuals with at least one high-risk condition accounted for 89.3% of those vaccinated. Uptake was higher (56.1%) for beneficiaries with high-risk conditions than for those without (27.6%).

Among unvaccinated beneficiaries overall, 77.4% visited a clinician during influenza season. Among unvaccinated beneficiaries with and without high-risk conditions, 91% and 43%, respectively, had seen a clinician at least once. The proportion of beneficiaries with missed opportunities for influenza vaccination was 44.2% and was higher for beneficiaries in the non-high-risk group (59.1%) than for those in the high-risk group (42.2%).

A higher percentage of White beneficiaries was vaccinated (52.9%) compared with Black (34.9%) and Hispanic (30.4%) beneficiaries. Uptake was also lower and proportions of missed opportunities were higher among beneficiaries in younger age groups without high-risk conditions and in those with Medicare-Medicaid dual eligibility.

The study authors observed that there were many opportunities during which these beneficiaries, including those at highest risk, could have been vaccinated, but these were missed both by primary care and specialty clinicians. They suggested that public health officials, policymakers, and clinicians engage in sustained, population-specific messaging to increase vaccination rates in vulnerable populations and complete influenza vaccination during routine appointments. Pharmacies could also help close the vaccination gap, the study authors noted. Among the high-risk group, most influenza vaccinations were given by primary care clinicians (44.8%) and pharmacists (40.7%).

“Medical specialists who treat Medicare beneficiaries should understand that ensuring all patients with underlying risk conditions receive the influenza vaccine is well within the scope of their responsibilities—whether that means administering the vaccine to their patients themselves or following up to ensure the vaccine is administered by another provider. All providers should incorporate adult immunization practice standards into clinical routines and strongly recommend influenza vaccine to patients, even if they do not administer it,” the study authors said.