Abstract
Introduction: Vaccination rates for influenza and COVID-19 remain low among people with chronic kidney disease (CKD). Nephrology care offers an opportunity to boost vaccination rates. Understanding provider perceptions can be key to developing effective intervention programs. Methods: We conducted a nationwide survey among nephrology care providers. In a questionnaire, we assessed the providers’ agreement with potential barriers to recommending influenza and COVID-19 vaccines and perceptions of selected vaccination programs on their acceptability, appropriateness, and feasibility. Results: Between February and June 2023, 312 providers responded to the survey. Most providers agreed that there is sufficient evidence for influenza vaccines (270/311, 86.8%) and that vaccines reduce the risk of serious complications of influenza (277/310, 89.4%). However, 40/312 (12.8%) felt that recommending influenza vaccines is less important than other issues they must address. By profession, more physicians agreed with the evidence (112/123 or 91.1% vs. 39/49 or 79.5% for NPs and 83/101 or 82.2% for RNs, p = 0.007) than nurse practitioners (NPs) or nurses (RNs). The most perceived barrier was lack of self-efficacy: 95/311 (30.5%) felt that many patients will not get vaccinated even if they recommend it. Similar responses were seen for COVID-19 vaccines. Regarding vaccination programs, 209/235 (88.9%), 197/224 (87.9%), and 183/222 (82.4%) providers considered provider reminders acceptable, appropriate, and feasible. 209/239 (87.4%), 198/226 (87.6%), and 187/224 (83.5%) did so for standing orders. Onsite/walk-in vaccinations were viewed as acceptable by 192/242 (79.3%) but less feasible (137/222 or 61.7%). Fewer than 33% of providers perceived patient incentives as acceptable, appropriate, or feasible. Conclusions: Most nephrology care providers believe that influenza and COVID-19 vaccinations offer evidence-based benefits, with slightly higher belief among physicians compared to NPs or RNs. However, important barriers to vaccination remain. Standing orders, provider reminders, and onsite/walk-in vaccination are favorably perceived by providers.
Journal Section:
Novel Research Findings
References
1.
Ishigami
J
, Grams
ME
, Chang
AR
, Carrero
JJ
, Coresh
J
, Matsushita
K
. CKD and risk for hospitalization with infection: the Atherosclerosis Risk In Communities (ARIC) study
. Am J Kidney Dis
. 2017
;69
(6
):752
–61
. 2.
James
MT
, Quan
H
, Tonelli
M
, Manns
BJ
, Faris
P
, Laupland
KB
, et al. CKD and risk of hospitalization and death with pneumonia
. Am J Kidney Dis
. 2009
;54
(1
):24
–32
. 3.
Martins-Filho
PR
, Tavares
CSS
, Santos
VS
. Factors associated with mortality in patients with COVID-19. A quantitative evidence synthesis of clinical and laboratory data
. Eur J Intern Med
. 2020
;76
:97
–9
. 4.
Clift
AK
, Coupland
CAC
, Keogh
RH
, Diaz-Ordaz
K
, Williamson
E
, Harrison
EM
, et al. Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study
. BMJ
. 2020
;371
:m3731
. 5.
Navaneethan
SD
, Schold
JD
, Arrigain
S
, Jolly
SE
, Nally
JV
. Cause-specific deaths in non-dialysis-dependent CKD
. J Am Soc Nephrol
. 2015
;26
(10
):2512
–20
. 6.
Behrouzi
B
, Bhatt
DL
, Cannon
CP
, Vardeny
O
, Lee
DS
, Solomon
SD
, et al. Association of influenza vaccination with cardiovascular risk: a meta-analysis
. JAMA Netw Open
. 2022
;5
(4
):e228873
. 7.
Rondy
M
, El Omeiri
N
, Thompson
MG
, Levêque
A
, Moren
A
, Sullivan
SG
. Effectiveness of influenza vaccines in preventing severe influenza illness among adults: a systematic review and meta-analysis of test-negative design case-control studies
. J Infect
. 2017
;75
(5
):381
–94
. 8.
Ishigami
J
, Sang
Y
, Grams
ME
, Coresh
J
, Chang
A
, Matsushita
K
. Effectiveness of influenza vaccination among older adults across kidney function: pooled analysis of 2005-2006 through 2014-2015 influenza seasons
. Am J Kidney Dis
. 2020
;75
(6
):887
–96
. 9.
Chen
CI
, Kao
PF
, Wu
MY
, Fang
YA
, Miser
JS
, Liu
JC
, et al. Influenza vaccination is associated with lower risk of acute coronary syndrome in elderly patients with chronic kidney disease
. Medicine
. 2016
;95
(5
):e2588
. 10.
Grandhi
GR
, Mozafarian
M
, Mszar
R
, Acquah
I
, Valero-Elizondo
J
, Cainzos-Achirica
M
, et al. Influenza vaccination among adults with CKD in the United States: regional, demographic, and socioeconomic differences
. Kidney Med
. 2021
;3
(3
):454
–6
. 11.
Barrett
TM
, Green
JA
, Greer
RC
, Ephraim
PL
, Peskoe
S
, Pendergast
JF
, et al. Advanced CKD care and decision making: which health care professionals do patients rely on for CKD treatment and advice
. Kidney Med
. 2020
;2
(5
):532
–42.e1
. 12.
Silver
D
, Kim
Y
, Piltch-Loeb
R
, Abramson
D
. One year later: what role did trust in public officials and the medical profession play in decisions to get a booster and to overcome vaccine hesitancy
. Prev Med Rep
. 2024
;38
:102626
. 13.
Hurley
LP
, Bridges
CB
, Harpaz
R
, Allison
MA
, O'Leary
ST
, Crane
LA
, et al. U.S. physicians’ perspective of adult vaccine delivery
. Ann Intern Med
. 2014
;160
(3
):161
. 14.
Centers for Disease Control and Prevention CDC
; Santibanez
T
, Bryan
L
. Place of influenza vaccination among adults — United States, 2010–11 influenza season
. MMWR Morb Mortal Wkly Rep
. 2011
;60
(23
):781
–5
.15.
National Vaccine Advisory Committee
; Gellin
BG
, Beigi
RH
. Recommendations from the national vaccine advisory committee: Standards for adult immunization practice
. Public Health Rep
. 2014
;129
(2
):115
–23
. 16.
Cabana
MD
, Rand
CS
, Powe
NR
, Wu
AW
, Wilson
MH
, Abboud
PA
, et al. Why don’t physicians follow clinical practice guidelines? a framework for improvement
. JAMA
. 1999
;282
(15
):1458
–65
. 17.
Summary CPSTF findings table for increasing vaccination | the community guide. Accessed November 21, 2023. Available from: https://www.thecommunityguide.org/pages/task-force-findings-increasing-vaccination.html
18.
Proctor
E
, Silmere
H
, Raghavan
R
, Hovmand
P
, Aarons
G
, Bunger
A
, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda
. Adm Policy Ment Health
. 2011
;38
(2
):65
–76
. 19.
Thomas
RE
, Lorenzetti
DL
. Interventions to increase influenza vaccination rates of those 60 years and older in the community
. Cochrane Database Syst Rev
. 2018
;5
(5
):CD005188
. 20.
Stinchfield
PK
. Practice-proven interventions to increase vaccination rates and broaden the immunization season
. Am J Med
. 2008
;121
(7 Suppl 2
):S11
–S21
. 21.
Yoshida
K
, Bartel
A
, Chipman
J
, et al. Tableone: create “table 1” to describe baseline characteristics with or without propensity score weights
. Published online April 15, 2022
.22.
Bryer
J
, Speerschneider
K
. Likert: analysis and visualization likert items
. Published online 2016
.23.
Lutz
CS
, Kim
DK
, Black
CL
, Ball
SW
, Devlin
RG
, Srivastav
A
, et al. Clinicians’ and pharmacists’ reported implementation of vaccination practices for adults
. Am J Prev Med
. 2018
;55
(3
):308
–18
. 24.
Granade
CJ
, Parker Fiebelkorn
A
, Black
CL
, Lutz
CS
, Srivastav
A
, Bridges
CB
, et al. Implementation of the Standards for adult immunization practice: a survey of U.S. Health care providers
. Vaccine
. 2020
;38
(33
):5305
–12
. 25.
Daniels
NA
, Nguyen
TT
, Gildengorin
G
, Pérez-Stable
EJ
. Adult immunization in university-based primary care and specialty practices
. J Am Geriatr Soc
. 2004
;52
(6
):1007
–12
. 26.
Fernandes
A
, Wang
D
, Domachowske
JB
, Suryadevara
M
. Vaccine knowledge, attitudes, and recommendation practices among health care providers in New York State
. Hum Vaccin Immunother
. 2023
;19
(1
):2173914
. 27.
Jessop
AB
, Dumas
H
, Moser
CA
. Delivering influenza vaccine to high-risk adults: subspecialty physician practices
. Am J Med Qual
. 2013
;28
(3
):232
–7
. 28.
Davis
MM
, Wortley
PM
, Ndiaye
SM
, Cowan
AE
, Osta
AD
, Clark
SJ
. Influenza vaccine for high-risk non-elderly adults: a national survey of subspecialists
. Hum Vaccin
. 2008
;4
(3
):229
–33
. 29.
Cataldi
JR
, O’Leary
ST
, Lindley
MC
, Hurley
LP
, Allison
MA
, Brtnikova
M
, et al. Survey of adult influenza vaccination practices and perspectives among US primary care providers (2016–2017 influenza season)
. J Gen Intern Med
. 2019
;34
(10
):2167
–75
. 30.
Hurley
LP
, Lindley
MC
, Allison
MA
, O'Leary
ST
, Crane
LA
, Brtnikova
M
, et al. Physicians’ use of evidence-based strategies to increase adult vaccination uptake
. Am J Prev Med
. 2020
;59
(3
):e95
–e103
. 31.
Fisher
KA
, Nguyen
N
, Crawford
S
, Fouayzi
H
, Singh
S
, Mazor
KM
. Preferences for COVID-19 vaccination information and location: associations with vaccine hesitancy, race and ethnicity
. Vaccine
. 2021
;39
(45
):6591
–4
. 32.
Fisher
KA
, Nguyen
N
, Fouayzi
H
, Singh
S
, Crawford
S
, Mazor
KM
. Impact of a physician recommendation on COVID-19 vaccination intent among vaccine hesitant individuals
. Patient Educ Couns
. 2023
;106
:107
–12
. 33.
de Wit
JBF
, Das
E
, Vet
R
. What works best: objective statistics or a personal testimonial? An assessment of the persuasive effects of different types of message evidence on risk perception
. Health Psychol
. 2008
;27
(1
):110
–5
. 34.
Jiang
LC
. Effects of narrative persuasion in promoting influenza vaccination in Hong Kong: a randomized controlled trial
. Patient Educ Couns
. 2021
;104
(4
):800
–7
. 35.
Malo
TL
, Hall
ME
, Brewer
NT
, Lathren
CR
, Gilkey
MB
. Why is announcement training more effective than conversation training for introducing HPV vaccination? A theory-based investigation
. Implementation Sci
. 2018
;13
(1
):57
–11
. 36.
Garrison
A
, Fressard
L
, Mitilian
E
, Gosselin
V
, Berthiaume
P
, Casanova
L
, et al. Motivational interview training improves self-efficacy of GP interns in vaccination consultations: a study using the Pro-VC-Be to measure vaccine confidence determinants
. Hum Vaccin Immunother
. 2023
;19
(1
):2163809
. 37.
Osaghae
I
, Darkoh
C
, Chido-Amajuoyi
OG
, Chan
, W
, Padgett Wermuth
, P
, Pande
, M
, et al, HPV vaccination training of healthcare providers and perceived self-efficacy in HPV vaccine-hesitancy counseling
. Vaccines
. 2022
;10
(12
):2025
. 38.
Adult vaccinations: team-based immunization: save time and prevent disease with an immunization program|patient care|AMA STEPS forward|AMA ed hub
. Accessed February 9, 2025. Available from: https://edhub.ama-assn.org/steps-forward/module/270255339.
Serre
J
, François
C
, der Haegen
MCV
, Papo
T
, Goulenok
T
, Sacre
K
. Nurse-led vaccination program dramatically improves pneumococcal vaccination coverage among patients with autoimmune inflammatory disorders
. Eur J Intern Med
. 2017
;43
:e43
–5
. 40.
Kaufman
J
, Attwell
K
, Hauck
Y
, Leask
J
, Omer
SB
, Regan
A
, et al. Designing a multi-component intervention (P3-MumBubVax) to promote vaccination in antenatal care in Australia
. Health Promot J Austr
. 2021
;32
(3
):391
–8
. 41.
Abramson
ZH
, Avni
O
, Levi
O
, Miskin
IN
. Randomized trial of a program to increase staff influenza vaccination in primary care clinics
. Ann Fam Med
. 2010
;8
(4
):293
–8
. 42.
Lollier
A
, Rodriguez
EM
, Saad-Harfouche
FG
, Widman
CA
, Mahoney
MC
. HPV vaccination: pilot study assessing characteristics of high and low performing primary care offices
. Prev Med Rep
. 2018
;10
:157
–61
. 43.
Dexter
PR
, Perkins
SM
, Maharry
KS
, Jones
K
, McDonald
CJ
. Inpatient computer-based standing orders vs physician reminders to increase influenza and pneumococcal vaccination rates: a randomized trial
. JAMA
. 2004
;292
(19
):2366
–71
. 44.
Srivastav
A
, Black
CL
, Lutz
CS
, Fiebelkorn
AP
, Ball
SW
, Devlin
R
, et al. U.S. clinicians’ and pharmacists’ reported barriers to implementation of the Standards for Adult Immunization Practice
. Vaccine
. 2018
;36
(45
):6772
–81
. 45.
Schneider
FH
, Campos-Mercade
P
, Meier
S
, Pope
D
, Wengström
E
, Meier
AN
. Financial incentives for vaccination do not have negative unintended consequences
. Nature
. 2023
;613
(7944
):526
–33
. 46.
Hogan
CM
, Parzuchowski
AS
, Lyu
X
, Goldstick
J
, Resnicow
K
. Characterization of US state COVID-19 vaccine incentive programs
. JAMA Netw Open
. 2022
;5
(10
):E2235328
. 47.
Wisconsin vaccine incentive program motivates thousands to get vaccinated in one month|CDC
(Accessed November 21, 2023) Available form: https://www.cdc.gov/vaccines/covid-19/health-departments/features/wisconsin-community.html48.
Jecker
NS
. Cash incentives, ethics, and COVID-19 vaccination
. Science
. 2021
;374
(6569
):819
–20
. 49.
Largent
EA
, Miller
FG
. Problems with paying people to Be vaccinated against COVID-19
. JAMA
. 2021
;325
(6
):534
–5
. 50.
Pennings
S
, Symons
X
. Persuasion, not coercion or incentivisation, is the best means of promoting COVID-19 vaccination
. J Med Ethics
. 2021
;47
(10
):709
–11
. 51.
Jacob
V
, Chattopadhyay
SK
, Hopkins
DP
, Murphy Morgan
J
, Pitan
AA
, Clymer
JM
, et al. Increasing coverage of appropriate vaccinations: a community guide systematic economic review
. Am J Prev Med
. 2016
;50
(6
):797
–808
. 52.
Groves
RM
. Nonresponse rates and nonresponse bias in household surveys
. Public Opin Q
. 2006
;70
(5
):646
–75
. 53.
Gaglio
B
, Shoup
JA
, Glasgow
RE
. The RE-AIM framework: a systematic review of use over time
. Am J Public Health
. 2013
;103
(6
):38
–46
. 54.
Damschroder
LJ
, Reardon
CM
, Widerquist
MAO
, Lowery
J
. The updated Consolidated Framework for Implementation Research based on user feedback
. Implement Sci
. 2022
;17
(1
):75
–16
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