Background/Purpose: Tumor necrosis factor α inhibitors (TNFi) predispose to bacterial infections including pneumonia. In turn, vaccination with pneumococcal 13 valent (PCV13) and pneumococcal 23 valent (PPSV23) afford prevent pneumonia. We evaluated the prevalence of pneumonia and vaccination rates in patients prescribed TNFi. To improve vaccination rates of patients started on TNFi and prevent pneumonia in these patients, we implemented a digital prompt within the Electronic Medical Record (EMR).

Methods: To improve vaccination rates of patients started on TNFi and prevent pneumonia in these patients, we implemented a digital prompt within the Electronic Medical Record (EMR). The digital prompt notifies providers of the vaccination status of PCV13 and PPSV23 for any patients for which a TNFi is prescribed at the time of the TNFi order entry. All adult patients from January 1, 2013-August 27, 2020 newly prescribed TNFi were put into a group labeled “Before Intervention.” Adult patients prescribed TNFi from August 28, 2020-April 7, 2021 were put into a group labeled “After Intervention”. Before and After Intervention corresponds to the start date of the digital prompt within our EMR. Diagnoses of pneumonia on ICD-10 codes, date of pneumonia diagnosis, pneumonia vaccinations, and date of initiation of the TNFi were collected for each group. A two-sided Chi Squared test was performed to find a relationship between vaccination and pneumonia occurrences in patients on TNFi in the before and after intervention groups.

Results: Data Collection shows 470 adults on TNFi from the After Intervention group and 4111 adults on TNFi in the Before Intervention Group. From the Before Intervention group, we assessed there is a 4.4% (181/4111) pneumonia vaccination rate and 6.2% (256/4111) prevalence of pneumonia in patients on TNFα-inhibitor (TNFi). In the After Intervention group, 16% (76/470) of patients on TNFi were vaccinated and there was a 7.9% (37/470) prevalence of pneumonia. There was a statistically significant increase in vaccination After Intervention group [p >0.0001] but there was no difference in pneumonia incidents [p=0.2006].

Conclusion: Our data shows that vaccinations of patients on TNFi improved after the implementation of the digital prompt. The rates of pneumonia did not improve. Our methods include pulling pneumonia based on the ICD-10 code. Notably, our data collection includes the COVID-19 pandemic. As such, there could be confounding factors, such as mask wearing, that might have reduced pneumonia incidence irrespective of receiving PCV13 and PPSV23 vaccines

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/implementation-of-digital-prompt-in-electronic-medical-records-improves-pneumonia-vaccination-rates-in-patients-prescribed-tnf-inhibitors/