Improving Vaccination Rates in Veterans With Inflammatory Bowel Disease

Abstract

Patients with inflammatory bowel disease (IBD) are at increased risk for vaccine preventable infections with additional risk from immunomodulators and biological agents used in the treatment of IBD. The goal of our study was to improve vaccination rates of veterans affected by IBD by having a dedicated nurse to track vaccinations and involve the primary care providers in contacting these veterans and administer the required vaccinations. The department of Gastroenterology at the Dayton Veterans Affairs Medical Center established an IBD clinic on the 1st of September, 2017 to consolidate the care of veterans with IBD. We assigned a dedicated nurse to this IBD clinic to track the vaccination status of each of the patients after reviewing the vaccine requirements based on the Center for Disease Control Advisory Committee on Immunization Practice Guidelines. The nurse then contacted the Primary Care Provider (PCP) for individual patients through a chart based electronic communication system. The PCPs then contacted their patients to complete the required vaccinations. The Vaccination status was then updated by the IBD nurse for each of the patients. Results: A total of 69 patients were enrolled in IBD clinic since its conception on 1 September 2017. Mean age was 55.8 ±15.3 years, and 88.4% were male. 52% of patients were diagnosed with Crohn's Disease, and 48 % of patients with Ulcerative Colitis. We calculated the percentage of patients vaccinated prior to establishing the IBD clinic. The next calculation included the number of newly vaccinated patients over the total number of unvaccinated patients as of 15th November 2019. Influenza vaccination rate did not change with IBD clinic intervention. Prior to intervention 47 patients (68.1%) had influenza vaccination, and 45 of patients (65.2%) received influenza vaccination after intervention. There were 39 of patients (56.5%) had Pneumococcal Conjugate Vaccine (PVC13) prior to intervention, and the rate of vaccination was increased by 23% (7/30) after intervention. Prior to intervention 58 patients (84.5%) had Pneumococcal Polysaccharide Vaccine (PPV23), and the rate increased by 36% (4/11) after intervention. Prior to intervention 19 patients (27.5%) had Hepatitis B vaccination, and the vaccination rate increased by 28% (14/50) after intervention. Prior to intervention 45 patients (66.7%) already had Adult Tetanus, Diphtheria, Pertussis (Tdap) vaccination o, and its vaccination rate increased by 65% (15/24) after intervention. One of the reasons for lack of improvement in influenza vaccination rates may be beliefs maintained by individual patients regarding perceived harmful effect of the flu vaccine, but this certainly requires further review. Vaccination uptake in the IBD patient population has been suboptimal for various postulated reasons including lack of adequate time by treating physician during patient encounter. Assigning a dedicated nurse to review the vaccination status of individual patients with IBD and involving their PCPs, greatly improved our vaccination rates in this vulnerable population. This intervention can also be extended to other preventive care aspects in patients with IBD, such as screening for osteoporosis, cancer and mental health issues.