Increasing pneumococcal vaccination for immunosuppressed patients: A cluster quality improvement trial

Brigham & Women's Hospital, Department of Medicine, Divisions of Rheumatology, Immunology, and Allergy. .
Arthritis & Rheumatology (Impact Factor: 7.48). 01/2013; 65(1). DOI: 10.1002/art.37716
Source: PubMed

ABSTRACT OBJECTIVE: Pneumoccocal vaccination is important for patients on immunosuppressive medications, but prior studies suggest that most patients do not undergo vaccination. We evaluated the effects of a point-of-care paper reminder form on being up-to-date with pneumococcal vaccination in a rheumatology practice. METHODS: Selected rheumatologists at five ambulatory practice sites received a point-of-care paper reminder form for patients who were not up-to-date with pneumococcal vaccination. Interrupted time-series analyses were used to measure the effect of the paper reminder form upon the intervention rheumatologists compared to the control rheumatologists. Adjusted Cox proportional hazards models were examined to identify independent predictors of being up-to-date with pneumococcal vaccination. RESULTS: We evaluated a total of 3,717 patients on immunosuppressive medications with 74.1% female, mean age of 53.7 years and 66.0% with rheumatoid arthritis. Rheumatologists who received the intervention had a significant increase in the rate of patients up-to-date with pneumococcal vaccination from 67.6% to 80.0% in the time period following the intervention (p=0.006), compared to control rheumatologists 52.3% to 52.0% (p=0.90). In regression models, the intervention [hazard ratio, HR=3.58, (95% CI 2.46-5.20)], having aprimary care physician affiliated with our hospital [HR=1.68, (95% CI 1.44-1.97)], diabetes mellitus [HR =1.57, (95% CI 1.02-2.41)] and patient age 56-65 years compared to age ≤ 45 years [HR=1.24, (95% CI 1.01-1.51)] were positive predictors of being up-to-date with vaccination. CONCLUSION: A simple point-of-care paper reminder for patients on immunosuppressive medications significantly increased the rate of being up-to-date with pneumococcal vaccination among intervention rheumatologists over a six-month period. © 2012 American College of Rheumatology.

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