Effectiveness of a Personal Vaccination Recommendation Letter to Liver Transplant Patients and Family Physicians for Improving the Vaccination Status: Improving Vaccinations: Whom to Contact?

BACKGROUND

Vaccination rates of immunosuppressed liver transplant recipients need to improve. We compared the effectiveness of a three-arm randomized intervention on vaccination rates in liver transplant recipients.

METHODS

Two hundred and eighty-nine liver transplant recipients were randomly assigned to three groups: (1) patient intervention, (2) family physician intervention, and (3) combined patient and family physician intervention. The intervention consisted of a yellow information letter, which was personalized and sent to either the patient (1), the family physician (2), or both (3) in December 2016.

RESULTS

Irrespective of the assigned intervention group, a significant increase in vaccination rates from baseline to follow-up after 2 years was observed for tetanus (53%-56%), pertussis (52%-57%), hepatitis A (44%-49%), hepatitis B (64%-71%), pneumococci (68%-75%), and the sequential pneumococcal vaccination (12%-22%). Comparing the interventions, the vaccination rate for hepatitis A was significantly higher at follow-up for intervention (3) (OR = 9.07, p = 0.043) and (2) (OR = 9.91, p = 0.034) than for intervention (1). Concerning the vaccination rate for hepatitis B, an odds ratio of 9.13 was observed for intervention (2) (p = 0.006) compared to (1). Interventions (2) and (3) were generally superior to the patient-centered intervention alone, with the exception of influenza vaccination.

CONCLUSION

The results show the importance of family physicians in improving vaccination rates in liver transplant recipients. Establishing low-threshold communication channels, for example, via the electronic patient record, could improve cooperation between physicians in specialized outpatient clinics and family physicians.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS: DRKS00035422). Registration was done retrospectively due to time constraints and lack of human resources.