Effective Intervention to Improve Viral Hepatitis Vaccination in Fellowsʼ Continuity Clinics

Abstract

Introduction: In patients with chronic liver disease, superimposed viral hepatitis may result in higher morbidity and mortality. Vaccination against viral hepatitis appears to be underutilized in these patients. This study aimed to: 1) determine baseline Hepatitis A and B vaccination patterns in fellows' continuity clinics; and 2) implement and assess an intervention to improve these patterns. Methods: Each GI fellow reviewed Hepatitis A and B vaccination history for patients seen by one cofellow between April 1 and June 30, 2015, at one of two continuity clinics. All patients with cirrhosis were eligible for inclusion; patients with Hepatitis B cirrhosis were only included for Hepatitis A vaccine assessment. Only the earliest visit for each patient during this period was included, to assess baseline vaccination patterns. The intervention to improve vaccination was implemented prospectively starting on November 12, 2015, and data collection continued until February 25, 2016. The intervention consisted of designing and using a template to prompt immunization history, serology testing, and vaccine orders. We compared post-intervention patterns with baseline patterns. Results: 14 fellows participated in the study. Baseline period included 244 cirrhotic patients. HAV vaccination was addressed in 23% of patients in one clinic, and 67% in the other clinic; the rates were 29% and 64% respectively for HBV. In the intervention phase, 206 cirrhotic patients were included. Vaccination significantly improved with the intervention: HAV was addressed in 74% of patients (p < 0.001) and 93% (p < 0.001) in each clinic respectively, and HBV in 82% (p < 0.001) and 92% (p < 0.001) respectively. Conclusion: Hepatitis A and B vaccinations were underutilized in cirrhotic patients at fellows' ambulatory sites. Our intervention, using a dedicated clinic template, improved awareness and the rate at which vaccination status was addressed in fellows' continuity clinics. Vaccination rates in patients with chronic liver disease can be improved as part of their overall plan of care.