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New Program Linked With Increased Rate of Shingles Vaccination for Patients With RA
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An electronically based alert program for primary care physicians was linked with an increased the rate of shingles vaccination among patients with rheumatoid arthritis, according to a recently published study.
“Primary care physicians may be unaware of guidelines related to [rheumatoid arthritis] RA diseases or may hesitate to prescribe a live vaccine in an immunosuppressed patient,” Heena Sheth, MD, MPH, in the Department of Medicine at the University of Pittsburgh School of Medicine (UPMC) and colleagues wrote. “Therefore, strong links for communication and education for patients and physicians are essential to improve the vaccination rates.”
To improve vaccination rates, Sheth and colleagues developed an electronic medical record (EMR)-based best practice alert (BPA) program that integrated vaccine eligibility verification, documentation and ordering. The researchers designed the alert system to enable physicians to either order the vaccine or — if they do not — document refusal and reason. The program also included an educational component of vaccine guidelines, BPAs and the vaccine process.
For the program, the researchers targeted patients older than 60 years who were treated with non-biologic immunosuppressive therapy for rheumatoid arthritis at 13 outpatient clinics between 2012 and 2013 for pre-intervention of the program (n = 1,823) and from 2014 to 2015 for post-intervention (n = 1,554). Researchers compared vaccination rates with the chi-squared test.
Researchers found the vaccination rate increased from 10.1% to 51.7% from pre- to post-intervention; the documentation rate increased from 28% to 72.9%; and the infection rate decreased from 2% to 0.3%, which was still significant.
“We used BPA in the EpicCare system, which is the EMR used in many institutions across the nation,” the researchers wrote. “This process can be easily adapted at other institutes and across the UPMC health system hospitals for all vaccinations.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Elizabeth Kirchner, MSN, CHP
Shingles is more common, more severe, and has more long-term sequelae in our patients with rheumatoid arthritis, yet the complexity of their care paradoxically leads to lower immunization rates. The important work done by Dr. Aggarwal and colleagues at the University of Pittsburgh illustrates how a small shift in work-flow and collaboration between team members can lead to significantly improved patient outcomes.
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