Background/Purpose:  American College of Rheumatology (ACR) 2015 guidelines for the treatment of rheumatoid arthritis (RA) include recommendations for immunization against influenza, pneumococcus, hepatitis B (Hep B) and herpes zoster (HZV). The guidelines also recommend the indications and timing of administration of these killed vaccines (pneumococcal, influenza and Hep B), and live attenuated HZV vaccinations. The aim of our study is to measure adherence rates to these ACR immunization recommendations in rheumatoid arthritis patients in our tertiary health care system based rheumatology practice and to identify opportunities to close the gap, if any.

Methods:  A retrospective review of the electronic health record (EHR) was performed to identify consecutive adult RA patients from January 1, 2016 to March 31, 2016 whose primary care physician (PCP) was within the affiliated health care system. Influenza vaccinations were captured only for the 2015-2016 flu season. In addition to the ACR recommendations for pneumococcal vaccinations, we determined the number of RA patients receiving the entire Advisory Committee on Immunization Practices (ACIP) recommended pneumococcal vaccination series. EHR review keywords included “vaccination,” “immunization,” “pneumococcal”, “flu”, “hepatitis”, “zoster” and whether vaccinations were offered, or refused by the patient.

Results:  A total of 85 adult RA patients were identified. The mean age was 61.5 yrs, 84.7% were female, 85.9% were Caucasian, and the mean duration of RA was 7.3 yrs. 82.4% were on a traditional DMARD, and 27.1% on a biologic DMARD. One patient was allergic to the influenza vaccination and was excluded. Of the remaining 84 patients who met the indications for influenza vaccination, 60.7% received the vaccination. 3.6% patients were offered the influenza vaccination but did not end up receiving it, and 10.7% refused vaccination. 52.9% of all RA patients received the pneumococcal vaccine. Of the three patients identified as being both at risk for Hep B (i.e. healthcare workers, intravenous drug abuse history and/or multiple sexual partners in last 6 months)and susceptible (anti-Hep B surface antibody negative), only one patient was subsequently vaccinated (33%). 29.2% of RA patients ≥ 50 years of age received the HZV vaccination. One HZV vaccine was deferred by the PCP secondary to prior initiation of immunosuppressant therapy. 16.7% received the entire ACIP recommended pneumococcal vaccination series.

Conclusion:  At our tertiary health care system rheumatology clinic, rates of adherence to ACR recommendations for vaccinations are sub-optimal. Some limitations of our data include vaccinations potentially received outside the clinic setting (e.g. pharmacies and retail stores), individual clinic vaccine stocking schedules and supplies, and vaccinations recorded prior to the July, 2015 launch date of our EHR, leading to attrition of data. Analysis of care gaps and future steps include vaccination guideline education, EHR integration of reconciliation and new vaccination orders, and subsequently re-measure adoption and adherence.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adherence-to-american-college-of-rheumatology-immunization-recommendations-for-rheumatoid-arthritis-patients-in-a-tertiary-care-health-system-and-opportunities-to-close-the-gap/