Background/Purpose: Rheumatology patients are at an increased risk of infection secondary to immunosuppressive medications used for disease management. However, vaccination is underutilized and rates remain low in this population despite guideline recommendation for receipt. Our aim was to improve pneumococcal vaccination rates in patients receiving biologic medications and to identify barriers to vaccination.

Methods: We implemented a multifaceted intervention within an adult rheumatology clinic at an academic medical center. Intervention included pharmacist pre-visit review of vaccination status, flagging charts with recommended vaccine, physician face-to-face discussion, and optional in-clinic nurse administration.

Results: 514 patients were reviewed prior to their visit. 369 were identified as eligible for pneumococcal vaccination. Of patients who were current with pneumococcal vaccination at the time of their visit, 34% had vaccination records located outside of our electronic medical record, primarily found in state immunization registries. Following five months of our intervention, 343 patients are now current with pneumococcal vaccinations, shifting those with an updated status from 28% to 67%. Of those that did not receive vaccination at time of visit, most common documented reasons were, no recommendation was identified within visit note, followed by patient will discuss with primary care physician.

Conclusion: Our intervention significantly improved pneumococcal vaccination rates and highlights the benefit of a multidisciplinary approach to optimize vaccination. Barriers to vaccination identified in our study emphasize confusion surrounding current guideline recommendations and the need for a reliable, transparent immunization record.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pneumococcal-vaccination-quality-improvement-initiative-within-a-rheumatology-clinic-at-an-academic-medical-center/