Vaccination Programs: Vital for At-Risk Gastroenterology Outpatients

Optimizing immunization rates by developing a vaccination program in outpatient gastroenterology has significant implications for preventing morbidity and mortality associated with vaccine-preventable diseases (VPD), researchers reported in Gastroenterology.

Gastroenterologists and hepatologists care for many patients who are at increased risk for VPD, but fewer than half of patients with inflammatory bowel disease (IBD), chronic liver disease (CLD), and liver transplantation receive appropriate vaccines, according to the study authors. One major barrier is not knowing whether gastroenterologists and hepatologists or primary care providers (PCPs) are responsible for recommending and administering vaccines. Many specialists think PCPs are responsible for vaccination, but PCPs may not know which vaccines are required for these patients and may have concerns about vaccinating immunosuppressed patients.

“To optimize immunization rates, gastroenterologists and hepatologists should play an active role in not only recommending vaccines, but also in sharing equal responsibility with PCPs in ensuring that patients are vaccinated,” stated the investigators, who developed 6 steps to implement a successful vaccination program in outpatient gastroenterology and hepatology practices.

Step 1 is to identify a vaccine champion, such as a physician, advanced practice provider, or pharmacist. “Buy-in from the entire office staff is critical for operations and successful utilization,” according to the study authors. “The vaccine champion should be familiar with recent vaccine recommendations and promote vaccination practices, including staff education and dispelling misperceptions that vaccines exacerbate underlying disease.”

Step 2 is to collaborate with the pharmacy department. “The pharmacy department in most outpatient practices oversees vaccine formulary, acquisition, and storage,” noted the researchers.

Step 3 is to optimize the practice space for vaccine administration. “Having vaccines readily available in your practice for administration will improve immunization rates,” stated the investigators. “A refrigerator with a temperature monitor solely for vaccine storage is needed.”

Step 4 is to collaborate with the information technology department. After administration, the vaccine product, dose, site and route of injection, lot number, and expiration date should be documented in the electronic health record, advised the study authors.

Step 5 is to train appropriate staff for vaccine administration and monitoring. “The individual administering vaccines should be familiar with injection techniques, vaccination storage, potential adverse events, and handling of medical emergencies, including anaphylaxis,” according to the researchers.

Step 6 is to establish contact with the billing department. “While vaccinations are unlikely to be an independent service line of revenue, the practice can generate income,” noted the investigators.

If gastroenterologists and hepatologists cannot set up an immunization service in their practice, they should use existing resources to optimize vaccination rates, advised the researchers. “Ideally, simply provide patients with a prescription for recommended vaccines,” they stated.

Coronavirus disease 2019 (COVID-19) has led to a decrease in vaccination rates. “Individuals with IBD, CLD, and liver transplant are already vulnerable populations; thus, ensuring that vaccines are still being administered when appropriate and in a timely manner despite the pandemic is essential,” noted the study authors.

“Successful implementation of a vaccination program can help overcome barriers to suboptimal vaccine rates and is feasible in outpatient gastroenterology practices,” the investigators concluded.

Disclosures: Some authors reported affiliations with pharmaceutical companies. Please see the original reference for a full list of disclosures.

Reference

Bhat S, Farraye FA, Hayney MS, Caldera F. How to implement a successful vaccination program in outpatient gastroenterology practices: a focus on patients with inflammatory bowel disease and chronic liver disease. Published online January 15, 2021. Gastroenterology. doi:10.1053/j.gastro.2021.01.026