Introduction: Immunosuppressive therapies increase risk of infections 2-fold when compared to naive individuals; however, an observational study found that only 4% of patients with psoriasis who were on or planned to start immunosuppressive therapy were immunized with pneumococcus. Factors positively influencing vaccination uptake include having vaccines available same day in clinic and education about vaccines. Negative influences include no recommendation from the treating clinician and no insurance. Failure to vaccinate occurs by overlooking indication and an uncertainty as to who is responsible for vaccination. Since the early 2000’s, vaccinations have been offered in pharmacies. This could result in additional confusion regarding vaccination responsibility. As a result of not being immunized, patients on immunosuppressive medications experience higher rates of preventable infections. We observed that many of our patients’ immunizations were incomplete and sought to increase immunization uptake through a quality improvement (QI) project beginning in Fall 2019. We evaluated the project’s approach of providing education with immediate onsite immunization availability relative to standard care to determine if vaccination uptake per CDC guidelines can be increased. Methods: We compared acceptance of CDC recommended pneumococcal immunization for patients on immunosuppressive therapy who were and were not subject to the QI project at the 2 urban dermatology clinics. Patients in the comparison group were under the care of other dermatologists. All patients in the QI group were educated on benefits of immunizations and offered immediate immunizations. Those who had never received the PCV13 or PPSV23 were defined as unimmunized. Patients who had received either vaccination were partially immunized. Patients who received both were completely immunized. We collected demographics and immunization status for all patients. Using Stata 14.2 [StataCorp, College Station, TX], we compared immunization status at baseline and final observations for patients in the QI and comparison groups using a multivariable ordered logit model, and used multiple logistic regression to examine receipt of a vaccination within the QI group. Results: The QI (N=146) and comparison groups (N=55) did not differ significantly on sociodemographic or clinical characteristics, including baseline immunization. After adjusting for patient characteristics, baseline immunization rates for fully, partially, and unimmunized patients were 9.2%, 28.7%, and 62.1% for the comparison group and 7.7%, 26.1%, and 66.3% for the QI group, respectively. Immunization statuses within the comparison group did not change over time, but at final observation 40.6%, 43.2%, and 16.1% of the QI group were fully, partially, and unimmunized, respectively (Table 1; p<0.001). Of patients in the QI group eligible for vaccination at baseline, 81% (105/129) received a vaccination. There was a significant association between immunization and insurance; uninsured patients in the QI group had significantly lower odds of receiving a vaccination (Table 2; p=0.015). Conclusion: Providing patients receiving immunosuppressive regimens with education and immediate vaccination access in a dermatology clinic significantly increased uptake of recommended pneumococcal immunization. Widespread use of this practice could reduce vaccine preventable illness and improve population health. Furthermore, there is a clear need for additional interventions targeting uninsured patients.
Purpose: To determine whether clinician-led immunization education with immediate onsite vaccination availability will increase pneumococcal immunizations during specialty care. Methods: We designed a controlled before and after QI project quasi-experimental design to retrospectively evaluate the QI effectiveness. The QI setting included two clinics. Clinic #1 was a part of the county hospital system and offered comprehensive care. Clinic #2 was a university clinic that hosted a private practice and a dermatology resident continuity clinic. 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit participated in the study. The intervention included clinician provided verbal immunization recommendations. Patients were then given the opportunity for immediate immunization. The main measure of outcome was pneumococcal immunization status after QI intervention. Results: Our analysis included 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit (aged 0-64 years [82.1%] ,aged ≥65 years [17.9%]; male [34.3%] female [65.6%%]). Of these, 146 [72.6%] were in the QI group and 55 [27.4%] in the comparison group. Our unadjusted analyses identified no significant group differences in immunization status at initial observation (p=0.329; Table 1). Of the 102 patients in the QI group with no pneumococcal immunizations at initial observation, 80.4% (95% CI: 71.4%, 87.1%) received at least one pneumonia vaccination by the final observation. For the 27 patients in the QI group with partial immunization at project initiation, 85.2% (95% CI: 65.9%, 94.5%) received at least one pneumonia vaccination. Overall, 81.4% (95% CI: 73.6, 87.3) of patients in the QI group without full immunization at initial observation received at least one vaccination by the final observation. Conclusion: These data demonstrate that immunization coverage in patients on immunosuppressive medications can be markedly improved by clinician recommendation with immediate availability of the pneumococcal vaccine during specialty care. Wider adoption of this model and its adaptation to other immunizations and settings is an important opportunity to reduce vaccine-preventable illness, including COVID-19, and improve population health.
Background: Individuals on immunosuppressive therapies experience greater morbidity and mortality due to vaccinepreventable illnesses, but there are low rates of adherence to immunization guidelines within this population.Objective: To determine the effectiveness of clinician-led education, patient-centered dialogue, and immediately available immunization on influenza vaccination uptake in patients taking immunosuppressive therapies.Method: We used a controlled before-and-after quasi-experimental design to evaluate our quality improvement intervention occurring from September 2019 to March 2020, with follow-up through July 2020. The study included 2 dermatology practices wherein nursing staff offered influenza vaccination during patient rooming (standard care). Within each practice, clinicians either implemented the intervention or provided only standard care. Patients received the intervention or standard care depending on the clinician they visited. Patients seen at the 2 clinics during the intervention period were included in analyses if they were taking or newly prescribed immunosuppressant medication at the time of their visit. We examined influenza immunization status for 3 flu
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