RA Patients Are Not Receiving Adequate Flu Vaccination

The use of multimodal interventions decrease the number of missed influenza vaccinations among patients with rheumatoid arthritis (RA), according to the results of a new study.

The rate of missed influenza vaccinations and whether interventions can positively impact uptake in an outpatient population is unknown.

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For their study, the researchers evaluated preintervention and postintervention outpatient visits of patients with RA to determine missed opportunities for vaccination. 

Missed opportunity for vaccination was defined as a visit in which a patient who was not vaccinated did not have contraindications to prevent vaccination, yet remained unvaccinated, or did not have the proper documentation in the electronic medical record (EMR) to do so.

Physicians applied a multimodal intervention that included an education session, EMR alerts, and weekly provider-specific email reminders.

A total 904 preintervention visits from 228 patients were analyzed. Of these, 197 patients returned for at least one postintervention visit, which accounted for 721 total postintervention visits.

The recurrence of any missed opportunity for influenza vaccination was 23% postintervention, compared with 47% preintervention.

For influenza vaccination post- versus preintervention, the relative hazard was 1.24 among patients who were vaccinated. 

Preintervention variables independently associated with missed opportunity included younger age, fewer number of office visits, higher erythrocyte sedimentation rate, and negative attitudes towards vaccinations.

While the variables were no longer associated with missed opportunities postintervention, the researchers found that the intervention was not as effective for non-Hispanic blacks, those who did not speak English, individuals residing outside the New York City metropolitan area, and for those who reported previous adverse effects to vaccines.

“Certain subgroups may need a more potent intervention for equivalent efficacy,” the researchers concluded.

—Melinda Stevens

Reference:
Broderick R, Ventura I, Soroosh S, et al. Reducing missed opportunities for influenza vaccination in patients with rheumatoid arthritis: evaluation of a multisystem intervention. J Rheum. 2018;45(9): 1220-1228. https://doi.org/10.3899/jrheum.170763.