Ambulatory Medication Safety: Vaccination and Laboratory Screening for Patients on Immunomodulatory Therapies
Document Type
Peer-Reviewed Article
Publication Date
2-2023
Abstract
Background: Immunomodulatory therapies improve the management of chronic diseases but can be associated with infectious risk. We examined the laboratory screening practices for Hepatitis B (HBV), Hepatitis C (HCV), and tuberculosis (TB) and rates of vaccination for pneumococcal and influenza in patients prescribed select immunosuppressive agents at our institution. Methods: A retrospective analysis was conducted to review patients who were prescribed a select immunosuppressive over three years. Data were extracted from electronic health records to identify rates of screening and vaccination prior initiation to or at any time. Logistic regression models were developed to identify predictors of screening and vaccination. Results: We identified 2,396 patients prescribed immunosuppressive medications by rheumatology (52.6%) and non-rheumatology specialties. Rates of screening at any time point were 84.5% (2025/2396) for HBV, 76.7% (1838/2396) for HCV and 71.8% (1720/2396) for TB. Patients who had either in-system primary care providers (PCPs) or rheumatologists were more likely to receive pneumococcal vaccinations (OR= 1.98, 95% CI [1.55, 2.54]; OR= 4.08, 95% [CI 2.76, 6.02] respectively). Patients with dermatologic (OR=1.67, 95% CI [1.14, 2.45]) or rheumatologic providers (OR=2.5, 95% CI [1.86, 3.36]) were more likely to be vaccinated for influenza. Conclusions: More than 70% of patients were screened for either HBV, HCV or TB at some point. Rates of pneumococcal vaccination were better than rates of influenza vaccination. Patients with in- system PCPs were more likely to be screened and vaccinated. Establishing and executing consistent processes for screening and vaccination prior to immunosuppressive treatment remains a priority in ambulatory settings.
DOI
10.1002/acr.24764
PMID
34350731
Recommended Citation
McDonnell, A. M., Iversen, M., Khinkar, R. M., Frits, M., Fiskio, J., & Desai, S. (2023). Ambulatory medication safety: Vaccination and laboratory screening for patients on immunomodulatory therapies. Arthritis Care & Research, 75(2), 437-444. Doi: 10.1002/acr.24764
Publication
Arthritis Care & Research
Volume
75
Issue
2
Publisher
Wiley
Pages
437-444
Comments
2021 August 4 published online ahead of print.