Improvement in the uptake and timing of influenza vaccination is possible among patients with rheumatoid arthritis (RA), many of whom often experience missed opportunities to be vaccinated, according to a recent evaluation of a multimodal intervention designed to improve immunization rates among outpatients at Columbia University Medical Center in New York City. The results of the study were published in The Journal of Rheumatology.

At each rheumatology outpatient visit, the investigators tracked missed opportunities for influenza vaccination, which were defined as a visit in which an unvaccinated patient with no contraindications remained unvaccinated or lacked documentation of immunization recommendation on his or her electronic medical record (EMR). Healthcare professionals received a multimodal intervention that included an educational session, EMR alerts, and weekly provider-specific email reminders. All missed opportunities both prior to and following the intervention were assessed and the reasons for missed opportunities were examined.

A total of 228 patients with RA were enrolled in the study (904 preintervention visits overall), and 197 participants returned for ≥1 postintervention visit (721 postintervention visits overall). Preintervention, the frequency of any missed opportunities for influenza immunization was 47%. This rate was reduced significantly to 23% postintervention (P <.001).


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Among vaccinated patients, the relative hazard for influenza vaccination, comparing time to vaccination in the postintervention period vs the preintervention period, was 1.24 (P =.0038), which indicated that significantly less time to vaccination was associated with use of the intervention. Less frequent office visits, younger age, negative attitudes about immunizations, and higher erythrocyte sedimentation rates were all independently associated with missed opportunities for vaccination preintervention. In the postintervention period, however, these factors were no longer linked to missed opportunities.

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Researchers noted that the intervention was not as effective among non-English-speaking individuals, non-Hispanic black patients, persons residing outside the New York City metropolitan area, and those who experienced prior adverse reactions to vaccines.

The investigators concluded that improved uptake of influenza immunization among patients with RA is possible with the use of a multimodal approach. Certain subgroups of patients may require a more powerful intervention to achieve comparable efficacy. The use of such interventions should help improve immunization rates among a patient population who are at higher risk of contracting influenza and of developing severe manifestations from the disease.

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Reference

Broderick R, Ventura I, Soroosh S, Franco L, Giles JT. Reducing missed opportunities for influenza vaccination in patients with rheumatoid arthritis: evaluation of a multisystem intervention [published online May 15, 2018].  J Rheumatol. doi: 10.3899/jrheum.170763