813 Access to tdap vaccine in outpatient offices and immunization uptake during pregnancy

Abstract

Many women do not receive the recommended tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine during pregnancy, increasing infants’ vulnerability in the first few months of life. Access to vaccination is a major barrier to uptake. Our hospital outpatient practice recommends that all pregnant patients receive Tdap but does not have in-office access to the vaccine; however, our hospital’s resident clinic at a Federally Qualified Health Center (FQHC) does have in-office access. We sought to evaluate the effect of in-office access to the vaccine during pregnancy on Tdap uptake. In this quality improvement initiative, patients who received prenatal care at the hospital practice or FQHC from January 1, 2018 through December 31, 2019 were identified by a review of electronic medical records. Maternal characteristics including age, employment status and insurance type were collected. Tdap uptake during pregnancy was compared between groups. Logistic regression was used to investigate effects of variables with p-values < 0.05 on Tdap uptake. All statistical analyses were performed using IBM SPSS Version 24.0. Significance levels of 0.05 (two-sided) were used. There were 2,279 patients included, with 1,866 (81.9%) patients in the hospital practice and 413 (18.1%) patients in the FQHC practice. We determined that 965 (51.7%) hospital patients received the Tdap vaccine compared to 327 (79.2%) FQHC patients. Patient demographics and Tdap uptake are described in Table 1. Logistic regression was used to investigate effects of care site, maternal age at delivery, employment status and insurance type on uptake of the Tdap vaccine. Patients at the hospital practice had 0.179 the odds of having received the Tdap vaccine than did FQHC patients (95% CI 0.135, 0.237) (Table 2). Receiving prenatal care at a FQHC with in-office access to the Tdap vaccine improved uptake. As such, it is important that providers’ offices be stocked with the vaccine for improved compliance with immunization recommendations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)