Reducing Missed Opportunities for Influenza Vaccination in Patients with Rheumatoid Arthritis: Evaluation of a Multisystem Intervention
Reducing Missed Opportunities for Influenza Vaccination in Patients with Rheumatoid Arthritis: Evaluation of a Multisystem Intervention
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DOI：
10.3899/jrheum.170763
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发表时间：
2018-08-01
影响因子：
3.9
通讯作者：
Giles, Jon T.
中科院分区：
文献类型：
--
作者：
Broderick, Rachel;Ventura, Iazsmin;Giles, Jon T.
Objective.评估一种多模式干预措施，以减少类风湿关节炎（RA）患者错过门诊流感疫苗接种的机会。RA患者从一个中心入组，跟踪每次风湿病门诊访视是否错过了流感疫苗接种机会，定义为无禁忌症的未接种疫苗患者仍然未接种疫苗或电子病历（EMR）中缺乏疫苗推荐记录的访视。然后，提供者接受多模式干预，包括教育课程，EMR警报和每周提供者特定的电子邮件提醒。比较干预前后的机会错失情况，分析影响机会错失的因素。共有228例RA患者入组（904次干预前访视），197例患者返回至少1次干预后访视（721次干预后访视）。干预前任何错过流感疫苗接种机会的频率为47%。干预后下降至23%（p < 0.001）。在接种疫苗的人群中，干预前后流感疫苗接种的相对风险为1.24（p = 0.038）。年龄较小、就诊频率较低、红细胞沉降率较高和对疫苗的消极态度分别与干预前错失的机会独立相关。干预后，这些因素不再与错过的机会相关;然而，干预在非西班牙裔黑人患者中并不有效。不讲英语的人。居住在纽约市大都市区以外的人群以及报告既往疫苗不良反应的人群。使用多模式方法可以提高RA患者的流感疫苗接种率。某些亚组可能需要更有效的干预以获得等效疗效。
Objective. To assess a multimodal intervention for reducing missed opportunities for outpatient influenza vaccination in individuals with rheumatoid arthritis (RA).Methods. Patients with RA were enrolled from a single center and each rheumatology outpatient visit was tracked for missed opportunities for influenza vaccination, defined as a visit in which an unvaccinated patient without contraindications remained unvaccinated or lacked documentation of vaccine recommendation in the electronic medical record (EMR). Providers then received a multimodal intervention consisting of an education session, EMR alerts, and weekly provider-specific e-mail reminders. Missed opportunities before and after the intervention were compared, and the determinants of missed opportunities were analyzed.Results. A total of 228 patients with RA were enrolled (904 preintervention visits) and 197 returned for at least 1 postintervention visit (721 postintervention visits). The preintervention frequency of any missed opportunities for influenza vaccination was 47%. This was reduced to 23% postintervention (p < 0.001). Among those vaccinated, the relative hazard for influenza vaccination post- versus preintervention period was 1.24 (p = 0.038). Younger age, less frequent office visits, higher erythrocyte sedimentation rate, and negative attitudes about vaccines were each independently associated with missed opportunities preintervention. Postintervention, these factors were no longer associated with missed opportunities; however, the intervention was not as effective in non-Hispanic black patients. non-English speakers. those residing outside of the New York City metropolitan area, and those reporting prior adverse reactions to vaccines.Conclusion. Improved uptake of influenza vaccination in patients with RA is possible using a multimodal approach. Certain subgroups may need a more potent intervention for equivalent efficacy.