Pneumococcal Polysaccharide Vaccination Among Patients With Diabetes, Asthma, and Cigarette Use

Streptococcus pneumoniae infection results in a variety of illnesses including ear and sinus infections, meningitis, and pneumonia. The Pneumovax 23 Vaccine (pneumococcal polysaccharide vaccine or PPSV23) helps protect against 23 strains of S. pneumoniae, and is indicated in adults 65 years old and older, children 2 years old and older at high risk for infection, and in those 19 to 64 years old who smoke or have asthma. Health care providers assess the risk of pneumococcal disease in each patient and administer the vaccination if indicated. The main reason patients remained unvaccinated was because vaccination was not addressed during the clinic visit. This was followed by the misclassification of high risk patients as low risk for infection and documented refusal, respectively. Patients with diabetes were more likely to be vaccinated than patients with asthma and patients who smoked tobacco. Pharmacists were the providers most likely to vaccinate patients. Pharmacists often help other providers manage patients with chronic disorders such as diabetes, asthma, and tobacco use, which may be why they vaccinate more high risk patients. These results show that pharmacists can play a larger role in identifying patients with medical indications to reduce missed vaccination opportunities.

Pneumococcal Polysaccharide Vaccination Among Patients With Diabetes, Asthma, and Cigarette Use Anthony Trovato, PharmD Candidate1; Karen Gunning, PharmD, BCPS, BCACP1,2; Karly Pippitt, MD, FAAFP2,3 of Utah College of Pharmacy, Salt Lake City, Utah; 2University of Utah Health Care Sugarhouse Family Practice Clinic, Salt Lake City, Utah; 3University of Utah School of Medicine, Salt Lake City, Utah Introduction / Background Streptococcus pneumoniae infection results in a variety of illnesses including ear and sinus infections, meningitis, and pneumonia.1,2 The Pneumovax 23 Vaccine (pneumococcal polysaccharide vaccine or PPSV23) helps protect against 23 strains of S. pneumoniae, and is indicated in adults 65 years old and older, children 2 years old and older at high risk for infection, and in those 19 to 64 years old who smoke or have asthma.3,4 Health care providers assess the risk of pneumococcal disease in each patient and administer the vaccination if indicated. Purpose • To determine the differences in vaccination rates of PPSV23 vaccination among patients with medical indications of diabetes mellitus, asthma, and cigarette smoking. • To determine whether patients with these indications did not receive the vaccine due to refusal, not being addressed by a provider, or being documented as low risk for infection and not being vaccinated despite a medical indication. • To assess whether differences occurred based on the type of provider seen in clinic and based on the indication for vaccination. Results The main reason patients remained unvaccinated was because vaccination was not addressed during the clinic visit. This was followed by the misclassification of high risk patients as low risk for infection and documented refusal, respectively. Patients with diabetes were more likely to be vaccinated than patients with asthma and patients who smoked tobacco. Pharmacists were the providers most likely to vaccinate patients. Pharmacists often help other providers manage patients with chronic disorders such as diabetes, asthma, and tobacco use, which may be why they vaccinate more high risk patients. These results show that pharmacists can play a larger role in identifying patients with medical indications to reduce missed vaccination opportunities. References 1. Nuorti JP, Whitney CG. Prevention of pneumococcal disease among infants and children use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59(RR-11):1-18. 2. Centers for Disease Control and Prevention. Prevention of Pneumococcal Disease Among Infants and Children --- Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. . 2010;59(RR11):1-18. 3. Centers for Disease Control and Prevention. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Children Aged 6-18 Years with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2013;62(25):521-524. 4. Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using 23-Valent Pneumococcal Conjugate Vaccine (PPSV23): Recommendations of the Advisory Committee on Immunization Practices (ACIP) [press release]. CDC2010. Vaccinated and Unvaccinated Patients by Provider Type Vaccinated and Unvaccinated Patients by Medical Indication 100 94 40 Cigarette Use 24 80 Methods / Process Chart review of 2 family medicine residency clinics revealed that 425 patients with any medical indication for PPSV23 were seen April 2015. Of these, 319 patients had a documented diagnosis of diabetes mellitus, asthma, or cigarette use. For patients with at least 1 of these medical indications, 146 did not receive the PPSV23 vaccine. One reviewer searched electronic medical records (EMRs) to assess reason for nonvaccination. The EMR search function was used to locate documentation of medical indications or mention of pneumococcal vaccination. Patients were then stratified into groups to assess if certain provider types were less likely to address PPSV23 vaccination, and if patients with a certain medical condition were less likely to be vaccinated. Conclusions Baseline Characteristics (n = 319) Age (median in years) 47 (IQR = 34 - 56) Gender 166 women; 153 men Vaccinated Patients 173 (54.2%) Unvaccinated Patients 146 (45.8%) Patients With Diabetes 151 (47.3%) Patients With Asthma 104 (32.6%) Patients Who Smoke Cigarettes 64 (20.1%) Faculty Visits 166 (52%) Medical Resident Visits 59 (18.5%) Physician Assistant Visits 82 (25.7%) Pharmacist Visits 12 (3.8%) Number of Patients 1University 61 Asthma 43 45 Diabetes 106 72 60 44 38 40 31 28 Disclosure 20 10 0 50 100 Number of Patients Unvaccinated Patients Vaccinated Patients 2 0 Medicine Faculty Medical Residents Vaccinated Patients Physician Pharmacists Assistants Unvaccinated Patients Authors of this presentation have the following to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation. Anthony Trovato: Nothing to disclose; Dr. Karen Gunning: Nothing to disclose; Dr. Karly Pippitt: Nothing to disclose