Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States.
Department of Internal Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, United States.
Medicine (Baltimore). 2022 Jul 29;101(30):e29786. doi: 10.1097/MD.0000000000029786.
Individuals on immunosuppressive therapies experience greater morbidity and mortality due to vaccine-preventable illnesses, but there are low rates of adherence to immunization guidelines within this population.
To determine the effectiveness of clinician-led education, patient-centered dialogue, and immediately available immunization on influenza vaccination uptake in patients taking immunosuppressive therapies.
We used a controlled before-and-after quasi-experimental design to evaluate our quality improvement intervention occurring from September 2019 to March 2020, with follow-up through July 2020. The study included 2 dermatology practices wherein nursing staff offered influenza vaccination during patient rooming (standard care). Within each practice, clinicians either implemented the intervention or provided only standard care. Patients received the intervention or standard care depending on the clinician they visited. Patients seen at the 2 clinics during the intervention period were included in analyses if they were taking or newly prescribed immunosuppressant medication at the time of their visit. We examined influenza immunization status for 3 flu seasons: 2017-2018 (preintervention), 2018-2019 (preintervention), and 2019-2020 (intervention).
Immunosuppressed patients initially declining an influenza vaccine were provided dermatologist-led education on the benefits of immunization. Dermatologists explored and addressed individual patients' immunization concerns. Influenza vaccination was then offered immediately postdialogue.
Analyses included 201 dermatology patients who were prescribed or currently taking immunosuppressive medication (intervention group [72.6%], comparison group [27.4%]). During the intervention period, 91.1% of the intervention group received influenza vaccination compared to 56.4% of the comparison group. Vaccination trends from 2018-2019 (preintervention) to 2019-2020 (intervention) differed significantly between groups (χ2 = 22.92, P < .001), with greater improvement in the intervention group. In 2019-2020, influenza vaccination was more likely in the intervention group relative to the comparison group (odds ratio: 16.22, 95% confidence interval: 5.55-47.38). In the subset of patients that had never received an influenza vaccine, influenza immunization in 2019-2020 was more common in the intervention group (75.8%, 25/33) relative to the comparison group (13.3%, 2/15, P < .001).
The intervention successfully addressed vaccine hesitancy and improved influenza immunization rates in an immunosuppressed population receiving care from a specialty clinic. Implementing a similar model across specialty clinics may improve vaccination rates for influenza, coronavirus disease 2019, and other vaccine-preventable illnesses in other populations.
接受免疫抑制治疗的个体因可通过疫苗预防的疾病而导致发病率和死亡率更高，但该人群对免疫接种指南的依从性较低。
确定临床医生主导的教育、以患者为中心的对话和立即提供免疫接种对接受免疫抑制治疗的患者进行流感疫苗接种的效果。
我们使用了对照前后的准实验设计来评估我们的质量改进干预措施，该干预措施于 2019 年 9 月至 2020 年 3 月进行，随访至 2020 年 7 月。该研究包括 2 个皮肤科诊所，在患者入诊室期间，护理人员提供流感疫苗接种（标准护理）。在每个诊所中，临床医生要么实施干预措施，要么仅提供标准护理。患者根据就诊的临床医生接受干预或标准护理。在干预期间在这 2 个诊所就诊且在就诊时正在服用或新开具免疫抑制剂的患者，如果在这 3 个流感季节中接受了流感免疫接种，则被纳入分析：2017-2018 年（干预前）、2018-2019 年（干预前）和 2019-2020 年（干预）。
最初拒绝接种流感疫苗的免疫抑制患者接受皮肤科医生主导的免疫益处教育。皮肤科医生探讨并解决了个别患者的免疫接种问题。然后在对话后立即提供流感疫苗接种。
分析纳入了 201 名正在服用或正在服用免疫抑制药物的皮肤科患者（干预组[72.6%]，对照组[27.4%]）。在干预期间，干预组中有 91.1%的患者接种了流感疫苗，而对照组中只有 56.4%的患者接种了流感疫苗。从 2018-2019 年（干预前）到 2019-2020 年（干预），组间的疫苗接种趋势差异显著（χ2 = 22.92，P <.001），干预组的改善更为明显。在 2019-2020 年，干预组接种流感疫苗的可能性高于对照组（优势比：16.22，95%置信区间：5.55-47.38）。在从未接种过流感疫苗的患者亚组中，干预组在 2019-2020 年接种流感疫苗的比例（75.8%，25/33）明显高于对照组（13.3%，2/15，P <.001）。
该干预措施成功地解决了疫苗犹豫问题，并提高了接受专科诊所护理的免疫抑制人群的流感免疫接种率。在其他专科诊所实施类似模式可能会提高其他人群对流感、COVID-19 和其他可通过疫苗预防的疾病的疫苗接种率。
