“The interventions outlined in our article can easily be implemented in pediatric rheumatology practices or other subspecialty clinics,” Dr. Julia G. Harris from Children’s Mercy Hospital, Kansas City, Mo., told Reuters Health by email. “It takes additional time, but is well worth the effort to improve the care of our patients.”
Deficient immune systems and immunosuppressive medications can place pediatric rheumatology patients at an increased risk of pneumococcal disease. These high-risk patients could benefit from the recommended vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23).
Before the intervention, only 6.7% of 305 patients at Children’s Hospital of Wisconsin Rheumatology Clinic, Milwaukee, the site of the study, were up to date on PCR 13, 8.9% were up to date for PPSV23, and none were up to date for both vaccines.
Dr. Harris’s team initiated a quality improvement project they hoped would increase PCV13 rates to 30% in the first four months.
The intervention included a discussion meeting, purchase of sufficient stocks of vaccine to implement the program, a formal presentation to providers and nurses of the current vaccination recommendations, and an immunization algorithm they displayed throughout the clinic to allow providers to determine if a pneumococcal vaccine was indicated.
In addition, weekly emails notified providers and nurses of scheduled patients who needed vaccination, and PCV13 or PPSV23 notices were stapled to the clinical encounter forms of patients who required vaccination.
The program was extended from four months to 13 months, during which average vaccination rates increased to 48.4% for PCV13, 28.4% for PPSV23, and 23.2% for both vaccines (all p<0.001), according to the Aug. 24 Pediatrics online report.
“Pneumococcal vaccination with both PCV13 and PPSV23 is important for patients on medications that suppress the immune system, in addition to other high-risk patients,” Dr. Harris said. “Simple interventions involving education and previsit planning can lead to improved vaccination rates.”
“Having motivated providers and staff in addition to a standardized process are also essential for patients to get this important preventative measure and reduce their risk of pneumococcal disease,” Dr. Harris said.
She added, “The study’s methodology to increase pneumococcal vaccination for patients at high risk for pneumococcal disease is widely applicable for both primary care and subspecialty providers in both pediatric and adult settings.”
The authors reported no external funding or relevant disclosures.