Improved influenza and pneumococcal vaccination in rheumatology patients taking immunosuppressants using an electronic health record best practice alert

Abstract

Objective. To examine whether an electronic health record (EHR) best practice alert (BPA), a clinical reminder to help guideline adherence, improved vaccination rates in rheumatology patients receiving immunosuppressants. Guidelines recommend yearly influenza and pneumococcal vaccination with revaccination for patients age >65 years who are taking immunosuppressive medications. Results. PostBPA influenza vaccination rates significantly increased (47% to 65%; P < 0.001), with significant improvement at both sites. PostBPA pneumococcal vaccination rates likewise significantly increased (19% to 41%; P < 0.001). PostBPA documentation rates for influenza and pneumococcal vaccinations also increased significantly. Site 2 (nursedriven) had significantly higher preBPA vaccination rates for influenza (69% versus 43%; P < 0.001) than pneumococcal (47% versus 15%; P < 0.001). Conclusion. The use of a BPA significantly increased influenza and pneumococcal vaccination and documentation rates in rheumatology patients taking immunosuppressants. A nurse-driven process offered higher efficacy. An EHR programmed to alert providers is an effective tool for improving quality of care for patients receiving immunosuppressants.

Attitude, knowledge and factors associated with influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immune deficiency

“…Literature review highlights three main findings supported by our study: vaccine coverage rates against influenza and pneumococcus are always suboptimal (from 34% to 63% and from 11%% to 39%, respectively) [36][37][38][39][40]; pneumococcal vaccination uptakes are lower than influenza vaccine uptakes; and vaccine uptake rates vary according to disease groups [35,[41][42][43].…”

“…The reported rate of vaccination against pneumococcus was 49% (95%CI [47][48][49][50]); 51% (95%CI [49-53]) in the AI group, 36% (95%CI [30][31][32][33][34][35][36][37][38][39][40][41][42][43]) in the Tx group and 39% (95%CI [33][34][35][36][37][38][39][40][41][42][43][44]) in the MBD group (Table 3).…”

Vaccination survey in patients with rheumatoid arthritis: a cross-sectional study

“…Improved comanagement between primary care and rheumatologists probably might improve this situation and lead to higher vaccination rates. In the United States, the use of an electronic health record with best practice alert signiWcantly increased inXuenza and pneumococcal vaccination in rheumatologic patients taking immunosuppressive drugs [23]. Therefore, speciWc national surveillance strategies seem to be required.…”

Practices of French family physicians concerning varicella vaccination for teenagers

“…The authors of a study in the USA reported that using a computerized medical file (French acronym = DMI) would increase the opportunity to update pediatric vaccinations with vaccinations performed earlier [15]. Likewise, a tool was set up in a rheumatology unit, reminding physicians when immuno-depressed patients needed to be vaccinated against the pneumococcus and influenza (electronic clinical reminder) [16]. The physicians had to either prescribe the vaccine or mention reasons for non-vaccination in the computerized alert system.…”