Use of Technology Can Improve Hepatitis A and Hepatitis B Vaccination Rates in Chronic Liver Disease Patients: A Prospective, Single-Center Study

Abstract

Purpose: Vaccination against Hepatitis A (HAV) and Hepatitis B (HBV) is recommended in chronic liver disease (CLD) patients. We have previously shown that patients presenting to the hepatology clinics often do not get the recommended vaccines. Use of computer based prompt, along with modified standing orders may be an effective method to improve the adherence rates. Methods: This is a prospective, single center trial aiming to study the effect of BPA on vaccination rates in CLD patients. BPA was designed to identify adult patients (>18 years age) with CLD (defined by ICD 9 codes) who presented to our tertiary care hepatology clinic. It was programmed to analyze previous hepatitis serology results in the system, identify the susceptible patients, and then alert the nurses. Patients were considered to be susceptible to HAV or HBV by BPA if they had negative serologies or if they did not have any serologies in the system. BPA then recommended pre built order sets for different vaccination series, which could be selected by the nurses. Upon approval of the vaccination series by the physician, vaccine was administered. We report our experience with vaccination rates in CLD patients seen from Feb 22, 2012- April 30, 2012 after BPA went live in our hepatology clinic. For comparison, baseline vaccination rates were obtained from a historical cohort of CLD patients presenting to the same clinic from 2005-2009 (data presented previously). Results: Total of 446 patients with CLD who were identified as either HAV or HBV susceptible by BPA were included (mean age 58.4 + 10.7 years). The major causes of chronic liver disease were chronic hepatitis C in 49.5% patients, non alcoholic fatty liver disease/ cryptogenic cirrhosis in 20.9%, and alcoholic liver disease in 8% patients. 83.1% of patients were HAV susceptible while 79.8% patients were identified as HBV susceptible. Hepatitis A vaccine had been initiated or completed in 70.8 % (263/ 371= 70.8%) of the susceptible patients as compared to 37.5% of the susceptible patients in the historical cohort in whom Hepatitis A vaccine had been initiated (p<0.0001). Similarly, 70.2% of the patients seen after implementation of BPA had initiation of HBV vaccination series as compared to 26.5% of Hepatitis B susceptible patients in the historical cohort (p<0.0001). Conclusion: Proportion of susceptible patients in whom Hepatitis A and Hepatitis B vaccination series were initiated almost doubled during the active alerting period. Use of technology seems to be a promising tool in improving adherence to vaccination guidelines in CLD patients.