Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project

Sheth, Heena; Moreland, Larry W.; Peterson, Hilary; Aggarwal, Rohit

doi:10.3899/jrheum.160179

Cited by 21 publications

(29 citation statements)

References 16 publications

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“…Out of five studies, three targeted providers and two providers and patients. The number of providers participating in the studies was generally small (8–35) or was not reported ( n = 3 studies) [ 21 , 24 , 25 ]. Patients in the studies ranged from 197 to 3717.…”

Section: Resultsmentioning

confidence: 99%

“…Patients in the studies ranged from 197 to 3717. The identified objective of the intervention was “improving vaccination rates” (in patients) [ 21 – 24 ], “reducing the frequency of any missed opportunities for vaccination” (in providers) [ 25 ], and “increase the documentation of prescriptions (in providers)” [ 21 , 24 ]. Three studies reported follow-up periods [ 22 , 23 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…All studies included interventions that targeted provider behavior to increase vaccination rates, and all provider interventions involved some form of vaccination reminder to discuss or prescribe vaccination as the primary intervention, including Electronic Health Record (EHR) or Electronic Medical Record (EMR) alerts and Point-of-care paper reminder forms. Only three studies also targeted patients and included education [ 24 ] or letters/e-mail reminders [ 23 , 25 ] to improve vaccination rates. Intervention components varied considerably between studies.…”

Section: Resultsmentioning

confidence: 99%

“…Among provider-targeted interventions, we identified a total of three BCTs used across the two studies and included: (1) adding objects to the environment (i.e., paper reminder forms, 1/2 studies) [ 22 ], (2) monitoring behavioral outcomes (EHR best practice alerts, 1/2 studies) [ 21 ], and (3) pharmacological support (provided vaccination documentation or advice to get vaccinated, 2/2 studies) [ 21 , 22 ]. Among patient-targeted interventions, we identified a total of five BCTs including (1) adding objects to the environment (i.e., paper reminder forms, 2/3 studies) [ 23 , 25 ], (2) providing feedback on behavior (i.e., performance feedback, 2/3 studies) [ 23 , 24 ], (3) monitoring behavioral outcomes (EMR-based alert, 2/3 studies) [ 24 , 25 ], (4) instruction on how to perform the behavior (educational session (s) with follow-up assessments; 2/3 studies) [ 24 , 25 ], and (5) pharmacological support (provided vaccination documentation or advice to get vaccinated, 3/3 studies) [ 23 – 25 ] (see Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Among patient-targeted interventions, we identified a total of five BCTs including (1) adding objects to the environment (i.e., paper reminder forms, 2/3 studies) [ 23 , 25 ], (2) providing feedback on behavior (i.e., performance feedback, 2/3 studies) [ 23 , 24 ], (3) monitoring behavioral outcomes (EMR-based alert, 2/3 studies) [ 24 , 25 ], (4) instruction on how to perform the behavior (educational session (s) with follow-up assessments; 2/3 studies) [ 24 , 25 ], and (5) pharmacological support (provided vaccination documentation or advice to get vaccinated, 3/3 studies) [ 23 – 25 ] (see Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Interventions to improve vaccine acceptance among rheumatoid arthritis patients: a systematic review

et al. 2019

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Introduction/objective National guidelines emphasize the importance of annual immunization for patients living with rheumatoid arthritis (RA), but vaccination rates remain suboptimal in this population. Evaluating the efficacy of patient and/or provider-targeted interventions to improve vaccination uptake among RA patients could inform practice. Methods We conducted a systematic review (SR) to examine the efficacy of interventions (exposure) aiming to improve vaccination uptake in patients with RA (outcome). English and French language, peer-reviewed interventional studies to improve vaccination rates in RA patients published between 2009 and 2018 were included. Results The search yielded a total of 450 records. Five articles met inclusion criteria. All interventions focused on changing provider behavior using some form of vaccination reminder as the primary intervention strategy, though only two studies reported provider prescribing behavior as an outcome (which was 4% and 58%). Overall, studies varied greatly regarding intervention delivery mode (e.g., educational sessions, e-mail reminders, best practice alerts), and behavior change techniques used to encourage providers to prescribe vaccination (e.g., feedback and monitoring, shaping knowledge, self-regulation). For influenza, pneumococcal and herpes zoster, post-intervention (mean 12–16 months follow-up) vaccination rates increased by a mean of 16.6% (± 15.4%). Conclusions Interventions to enhance vaccine uptake in RA focused almost exclusively on improving provider prescription of vaccines using reminder-type interventions. Although effective in improving vaccination rates, those studies used heterogeneous interventions and behavior change techniques. Few studies measured provider prescribing behavior as an outcome. Future studies targeting providers should measure relevant provided-related outcomes and their impact on patient outcomes, to determine overall efficacy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Interventions to improve vaccine acceptance among rheumatoid arthritis patients: a systematic review

et al. 2019

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Avoidable Acute Care Use for Vaccine‐Preventable Illnesses Among Medicaid Beneficiaries With Lupus

Feldman

Costenbader

2021

Arthritis Care & Research

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Objective Nearly 25% of patients with systemic lupus erythematosus (SLE) are hospitalized yearly, often for outcomes that may have been avoided if patients had received sustained outpatient care. We examined acute care use for vaccine‐preventable illnesses to determine sociodemographic contributors and modifiable predictors. Methods Using US Medicaid claims from 29 states (2000–2010), we identified adults (18–65 years) with prevalent SLE and 12 months of enrollment prior to the first SLE code (index date) to identify baseline data. We defined acute care use for vaccine‐preventable illnesses as emergency department (ED) or hospital discharge diagnoses for influenza, pneumococcal disease, meningococcal disease, herpes zoster, high‐grade cervical dysplasia/cervical cancer, and hepatitis B after the index date. We estimated the incidence rate of vaccine‐preventable illnesses and used Cox regression to assess risk (with hazard ratios and 95% confidence intervals) by sociodemographic factors and health care utilization, adjusting for vaccinations, comorbidities, and medications. Results Among 45,654 Medicaid beneficiaries with SLE, <10% had billing claims for vaccinations. There were 1,290 patients with ≥1 ED visit or hospitalization for a vaccine‐preventable illness (6.6 per 1,000 person‐years); 93% of events occurred in unvaccinated patients. Patients who were Black compared to White had 22% higher risk. Greater outpatient visits were associated with lower risk. Conclusion Medicaid beneficiaries with SLE who are not vaccinated are at risk for potentially avoidable acute care use for vaccine‐preventable illnesses. Racial disparities were noted, with a higher risk among Black patients compared to White patients. Greater outpatient use was associated with reduced risk, suggesting that access to ambulatory care may reduce avoidable acute care use.

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Improving hepatitis B vaccination rates for advanced chronic kidney disease patients: a quality improvement initiative

et al. 2021

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Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project

Abstract: Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician's time, and has the potential for self-sustainability and generalizability.

Cited by 21 publications

References 16 publications

Interventions to improve vaccine acceptance among rheumatoid arthritis patients: a systematic review

Interventions to improve vaccine acceptance among rheumatoid arthritis patients: a systematic review

Avoidable Acute Care Use for Vaccine‐Preventable Illnesses Among Medicaid Beneficiaries With Lupus

Improving hepatitis B vaccination rates for advanced chronic kidney disease patients: a quality improvement initiative

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