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Ambulatory Medication Safety: Vaccination and Laboratory Screening for Patients on Immunomodulatory Therapies.

BACKGROUND
Immunomodulatory therapies improve the management of chronic diseases but can be associated with infectious risk. We examined the laboratory screening practices for Hepatitis B (HBV), Hepatitis C (HCV), and tuberculosis (TB) and rates of vaccination for pneumococcal and influenza in patients prescribed select immunosuppressive agents at our institution.


METHODS
A retrospective analysis was conducted to review patients who were prescribed a select immunosuppressive over three years. Data were extracted from electronic health records to identify rates of screening and vaccination prior initiation to or at any time. Logistic regression models were developed to identify predictors of screening and vaccination.


RESULTS
We identified 2,396 patients prescribed immunosuppressive medications by rheumatology (52.6%) and non-rheumatology specialties. Rates of screening at any time point were 84.5% (2025/2396) for HBV, 76.7% (1838/2396) for HCV and 71.8% (1720/2396) for TB. Patients who had either in-system primary care providers (PCPs) or rheumatologists were more likely to receive pneumococcal vaccinations (OR= 1.98, 95% CI [1.55, 2.54]; OR= 4.08, 95% [CI 2.76, 6.02] respectively). Patients with dermatologic (OR=1.67, 95% CI [1.14, 2.45]) or rheumatologic providers (OR=2.5, 95% CI [1.86, 3.36]) were more likely to be vaccinated for influenza.


CONCLUSIONS
More than 70% of patients were screened for either HBV, HCV or TB at some point. Rates of pneumococcal vaccination were better than rates of influenza vaccination. Patients with in-system PCPs were more likely to be screened and vaccinated. Establishing and executing consistent processes for screening and vaccination prior to immunosuppressive treatment remains a priority in ambulatory settings.