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.

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/2702553
39.
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.html
48.
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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