Patients with inflammatory bowel diseases (IBD) are at an increased risk of pneumonia, and using immunosuppressive medications further increases this risk. Hospitalized patients with IBD have a significantly higher mortality rate from infections with pneumonia being one of them. The American College of Gastroenterology recommends pneumococcal vaccination for all IBD patients as a part of preventative care for IBD patients. However, compliance rates of pneumococcal vaccination in IBD patients have been very low. Quality improvement projects in this regard have been successful at demonstrating increased immunization rates. Our quality improvement project was aimed at increasing pneumococcal vaccination rates in these adult IBD patients by establishing a process to identify eligible patients in primary care clinics.
A total of 95 adult patients (under age 65) with IBD who were treated with immunosuppressants and had clinic visits in 2 primary care clinics (one internal medicine residents’ continuity clinic, and one primary care clinic without residents) from January 2010 to December 2020 were screened for their eligibility for pneumococcal vaccination and immunosuppressed status. Eligible patients were contacted via phone to schedule a clinic visit to receive pneumococcal vaccinations and reasons for refusal were documented. All the physicians, physician assistants, and nursing staff were informed of the project, and the plan was set up to identify yearly champions in each clinic whose patients are up to date with their pneumococcal vaccinations to ensure the project's sustainability. Data were collected and analyzed using descriptive statistics. Fisher’s exact test compared patients with updated pneumococcal vaccination to those not up to date. McNemar’s exact test compared the before and after vaccination status.
A total of 95 patients (28 patients with ulcerative colitis and 67 patients with Crohn’s disease) treated with immunosuppressant medications were evaluated and only 10 patients (10%) were up to date with pneumococcal vaccination. 56 patients (58%) had not started pneumococcal vaccinations and were due to receive PCV 13 and 29 patients (30%) were due for PPSV 23. After the intervention, 32 patients (33.6%) had received pneumococcal vaccination at 6 months follow-up. 16 patients (16%) refused to get pneumococcal vaccination until after the consultation with their primary gastroenterologists and had not received the immunization at 6 months follow-up. The compliance rate of pneumococcal vaccinations was increased by 23% (p
Patients with inflammatory bowel disease are at risk for vaccine-preventable illnesses, and pneumococcal vaccination rates are consistently low in this patient population. A simple primary care clinic-based intervention described in our project significantly improved the pneumococcal vaccination rate.
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Naing L, Malik S, Bapaye J, Jadhav N. Quality Improvement Project to increase pneumococcal vaccination rates in adults with inflammatory bowel diseases (IBD) being treated with immunosuppressants.. Advances in Clinical Medical Research and Healthcare Delivery. 2023; 3(2). doi: 10.53785/2769-2779.1141.