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A quality improvement intervention failed to significantly increase pneumococcal and influenza vaccination rates in immunosuppressed inflammatory arthritis patients

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Abstract

Objectives

Pneumococcal and influenza vaccination rates have been suboptimal in studies of immunosuppressed patients. We aimed to assess barriers to and increase rates of 23-valent pneumococcal polysaccharide vaccine (PPSV23) and influenza vaccination in this group. The primary endpoint was a statistically significant increase in adequate PPSV23 and influenza vaccination.

Methods

In 2017, rheumatology outpatients completed an anonymous questionnaire recording vaccination knowledge, status, and barriers. Simultaneously, a low-cost multifaceted quality improvement (QI) intervention was performed. All outpatients on oral steroids, immunosuppressant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologics disease-modifying antirheumatic drugs (bDMARDs) were included in the study. In 2018, post-intervention, the clinic was re-assessed. Demographics, diagnosis, medications, smart phone access, and willingness to use this for vaccination reminders were assessed for independent vaccination predictors using binary logistic regression analysis.

Results

Four hundred twenty-five patients were included (72.6% rheumatoid arthritis, 74% women, 45.6% ≥ 60 years old). From 2017 to 2018, PPSV23 vaccination rates changed from 41.0 to 47.2% (P = 0.29) and influenza from 61.8 to 62.1% (P = 0.95). The most common reason for non-vaccination was lack of awareness. Following the intervention, this changed for influenza (36.7 to 34.2%) and PPSV23 (82.1 to 76.4%). General practitioners performed most vaccinations, only 3.6% were delivered in the hospital. Significant predictors of PPSV23 vaccination were older age {≥ 80 years had an OR 41.66 (95% CI 3.69–469.8, P = 0.003), compared with ≤ 39 years}, bDMARD use (OR 2.80, 95% CI 1.24–6.32, P = 0.013), and adequate influenza vaccination (OR 9.01, 95% CI 4.40–18.42, P < 0.001). Up-to-date PPSV23 vaccination (OR 8.93, 95% CI 4.39–18.17, P < 0.001) predicted influenza vaccination.

Conclusions

PPSV23 and influenza vaccination rates were suboptimal. The intervention did not cause a statistically significant change in vaccination rates. Point-of-care vaccination may be more effective.

Key Points

• Low vaccination rates amongst immunosuppressed inflammatory arthritis outpatients

• Less than 5% of vaccinations occurred in hospital

• There was no statistically significant difference in the rates of adequate PPSV23 (41.0 to 47.2%) or influenza (61.8 to 62.1%) vaccination following our intervention

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Authors and Affiliations

  1. Department of Rheumatology, Saint Vincent’s University Hospital, Dublin 4, Ireland

    Kieran Murray, Candice Low, Francis Young & Douglas James Veale

  2. Department of Infectious Diseases, Saint Vincent’s University Hospital, Dublin 4, Ireland

    Anna O’Rourke & Eoin Feeney

  3. Clinical Audit, Saint Vincent’s University Hospital, Dublin 4, Ireland

    Ian Callanan

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  1. Kieran Murray
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  2. Candice Low
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Correspondence to Kieran Murray.

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This study was approved by the Clinical Audit Committee, Saint Vincent’s University Hospital.

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Murray, K., Low, C., O’Rourke, A. et al. A quality improvement intervention failed to significantly increase pneumococcal and influenza vaccination rates in immunosuppressed inflammatory arthritis patients. Clin Rheumatol 39, 747–754 (2020). https://doi.org/10.1007/s10067-019-04841-6

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  • DOI: https://doi.org/10.1007/s10067-019-04841-6

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