Dementia UK and The Charity for Civil Servants teamed up to test the acceptability and feasibility of delivering a work-based Admiral Nurse clinic to support family carers during their employed working hours. This paper presents some of the learning from this innovative approach.
Background:The increasing use of immunosuppressive drugs and reports of infection rates in rheumatoid arthritis (RA) registries highlights the need to understand rates of common vaccinations, influenza and pneumococcal, and attitudes to vaccination in Australian RA cohorts.
Aims:To investigate influenza and pneumococcal vaccination rates and attitudes to vaccination in a specialist RA clinic and to examine the infection risk in unvaccinated patients Methods: A cross sectional study of 193 consecutive RA clinic patients was performed using a survey of influenza and pneumococcal vaccination status, and reasons for non-vaccination were documented. Infection risk in non-or never-vaccinated patients was calculated using the Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT) risk score.Results: RA cohort demographics were representative of a standard RA population. 70% of patients were seropositive and 29% were current smokers. 83% of patients were on a non-biological disease modifying anti-rheumatic drug, most commonly methotrexate (67%) and hydroxychloroquine (33%). 38% of patients were on biological disease modifying anti-rheumatic drugs (bDMARDs), predominantly anti-TNF alpha inhibitors. 43% of patients were currently taking steroids. The mean DAS28 in this cohort was 3.3, suggesting moderately active disease. 34% of patients were unvaccinated, of which half (51%) had never been vaccinated. In the never vaccinated group and the not-currently vaccinated group, the commonest reason for non-vaccination was 'worries about the safety of the vaccine, including side effects'. The mean age in the non-vaccinated group was 48, the mean steroid dose was 1.96 mg, average numbers of DMARDs in this group was 2.9 concomitant biologic therapy was prescribed in 46% of patients. The risk of infection was between 1.4 -3.5%/year.
Conclusion/impact:This study highlights incomplete influenza and pneumococcal vaccination in an at-risk immunosuppressed Australian RA cohort. Concern regarding vaccine safety was the primary reason for non-vaccination. This highlights the need to tailor information strategies to particular sub groups within the cohort. The uptake of emerging vaccines is likely to be influenced by prevailing attitudes to vaccination and a patient centred approach which quantifies and explains risk -benefit for individual patients may be required to translate the therapeutic impact to whole cohorts of immunosuppressed patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.