The Effect of Offering Pneumococcal Vaccines During Specialty Care on Vaccination Rates in Patients Receiving Immunosuppressive Therapy

Purpose: To determine whether clinician-led immunization education with immediate onsite vaccination availability will increase pneumococcal immunizations during specialty care. Methods: We used a controlled before and after quasi-experimental design to retrospectively evaluate quality improvement (QI) project effectiveness. The project included two clinics. Clinic #1 was a part of the county hospital system and offered comprehensive care. Clinic #2 was a university clinic that hosted a private practice and a dermatology resident continuity clinic. Resident continuity clinics are structured to enable residents to develop longitudinal relationships with patients with skin disease. Patients within each of these clinics were subject to the intervention or usual care based on their treating physician. The intervention included clinician-provided verbal immunization recommendations, dialogue exploring and addressing patients’ immunization concerns, and immediate availability of vaccine and administration. The main measure of outcome was pneumococcal immunization status after QI intervention. Results: Our analysis included 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit (aged 0-64 years [82.1%], aged ≥65 years [17.9%]; male [34.3%], female [65.6%%]). Of these, 146 [72.6%] were in the QI group and 55 [27.4%] in the comparison group. While we identified no significant QI/comparison group differences in immunization status at initial observation (p=0.329), immunization status differed significantly by group at the final observation (p<0.001). The QI group had a significant increase in immunization status compared to the comparison group (p<0.001). Overall, 81.4% (95% CI: 73.6, 87.3) of patients in the QI group without full immunization at initial observation received at least one vaccination by the final observation, while we observed no change in immunization status for the comparison group from initial to final observation. Conclusion: These data demonstrate that immunization coverage in patients on immunosuppressive medications can be markedly improved by clinician recommendation with immediate availability of the pneumococcal vaccine during specialty care. Wider adoption of this model and its adaptation to other immunizations and settings is an important opportunity to reduce vaccine-preventable illness, including COVID-19, and improve population health.