Friday Shorts: Pharmacy vaccination, cervical cancer, flu and COVID shots, surgical bias and telehealth

March 21, 2025

A) Pedi vaccination in pharmacies doesn’t lead to lower rates of well child visits

Local pharmacies have become a major source of childhood and adult vaccinations, and some have worried that parents who bring their child to a pharmacy for a vaccination might skip routine pediatrician or family medicine visits. These routine visits are important to allow clinicians to check for developmental delays, early signs of chronic diseases, and even signs and symptoms of child abuse. Researchers in Health Affairs Scholar used the Marketscan claims database (over 25 million people under age 65) to assemble matched cohorts of around 4600 children ages 4 to 8, and around 35,000 children 9-17.

They found that there was no statistically significantly different rate of primary care visits or vaccination rates between the pharmacy and the primary care groups. There was a slight decrease in primary care visits in the younger children using pharmacy for vaccination, and a slight increase in primary care visits in the older children using pharmacy for vaccination. Neither of these reached statistical significance.

We should promote childhood vaccines in any setting without worrying that offering vaccination in pharmacies will diminish appropriate pediatric preventive care. Employers should offer coverage for vaccination without cost sharing through the medical benefit and the pharmacy benefit to maximize the chances that children will obtain their age-appropriate vaccinations.

B) Cervical cancer rates continue to decline

Source: Gargano, et al CDC February 27, 2025 CIN3+ is cervical intraepithelial dysplasia.

The CDC reports that CIN3+ (cervical intraepithelial dysplasia), an invasive precursor to cervical cancer, has declined by 80% in women between ages 20-24. Slightly less invasive CIN2 decreased by 79% in this age group. This is a continued indication of the benefit of HPV vaccines. The Advisory Committee on Immunization Practices recommends two doses of HPV vaccine at ages 11 or 12. The vaccination can be given to children as young as age 9; those children or adults beginning vaccination after age 15 need three doses. This vaccine is covered without cost sharing in plans compliant with the Affordable Care Act. Here are links to some past posts on this topic:

● HPV vaccines led to a decrease in cervical cancer deaths (December, 2024)

● HPV vaccines prevented cervical cancer especially if administered before age 14 (February, 2024)

● Rural-urban and racial disparities in cervical cancer persist (March, 2025)

C) Surgeons with implicit bias more likely to perform low-value procedure

Researchers in JAMA Surgery correlated implicit bias of vascular surgeons determined by a validated survey tool with actual surgery performed by that surgeon. They found that about 70% of surgeons had a pro-White bias, and they were 28[1] % more likely to perform a vascular surgery for exertional leg pain on Black patients (infrapopliteal revascularization) which is associated with higher risk of amputation. Indeed, Black patients treated by surgeons with a pro-White bias had a higher amputation rate. Those surgeons without a pro-White bias did not have a higher rate of performing this surgery, and their Black patients did not have a higher amputation rate. This was a small study but shows the importance of population review of outcomes by population segment. This study also demonstrates a potential place where health plan prior authorization or retrospective review could help improve quality of care.

D) COVID and influenza vaccines were effective this year

Source: Frutos, et al CDC February 27, 2025. I have averaged results of multiple different CDC-reported studies.

The Centers for Disease Control and Prevention (CDC) presented preliminary data on the efficacy of 2024-25 COVID-19 and influenza vaccinations in late February, and the results look quite good. Those who were vaccinated against influenza were 45% less likely to have an outpatient visit and over two-thirds (71%) less likely to have an inpatient stay. Adults vaccinated against COVID-19 were about a third less likely to have an ambulatory visit for that disease and half less likely (45%) to be hospitalized for COVID[JL2] .

E) Telehealth prescription of stimulants not an independent risk factor for higher rate of substance use disorder

Researchers in Health Affairs compared the medical claims for about 56,000 who were given an initial prescription for a stimulant in 2021 at an office visit with about 21,000 who were prescribed stimulants through a telemedicine service. They found that those who obtained prescriptions through telemedicine were somewhat more likely to be diagnosed with a substance use disorder (SUD) in the following 365 days; however, this increase was explained by previous psychiatric disease or SUD. The statistical regression model showed that those prescribed stimulants through telehealth were not statistically significantly more likely to be diagnosed with SUD in the following year. Access to in-person mental health care continues to be a challenge, and this research provides reassurance to employers covering telehealth prescription of stimulants. Clinicians providing telemedicine stimulant prescriptions should be mindful of the potential of SUD, especially in adults 26-34.