Friday, August 9, 2013

Even Liver Specialists Fail to Immunize Patients Against Viral Hepatitis

Hepatologists—physicians who specialize in treating liver disease—are failing to recommend hepatitis A and B immunizations to patients with chronic hepatitis C and other liver ailments, according to a study by University of Pittsburgh School of Medicine researchers.

The study, published in the July issue of PLoS One, found that even in an academic clinic specializing in liver disease, hepatologists recommended immunization for hepatitis A in only 63% of eligible patients and for hepatitis B in 59.7% of eligible patients.

Appropriate immunization recommendations, which matched current medical practice recommendations, varied from 30% to 98.6% among the liver specialist.

Source: http://www.ncbi.nlm.nih.gov/pubmed/23923056

—Christine. M. Kukka, Project Manager, HBV Advocate

Abstract: Physicians infrequently adhere to hepatitis vaccination guidelines for chronic liver disease. 

Thudi K, Yadav D, Sweeney K, Behari J. Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.

BACKGROUND AND GOALS:
Hepatitis A (HAV) and hepatitis B (HBV) vaccination in patients with chronic liver disease is an accepted standard of care. We determined HAV and HBV vaccination rates in a tertiary care referral hepatology clinic and the impact of electronic health record (EHR)-based reminders on adherence to vaccination guidelines.

METHODS:
We reviewed the records of 705 patients with chronic liver disease referred to our liver clinic in 2008 with at least two follow-up visits during the subsequent year. Demographics, referral source, etiology, and hepatitis serology were recorded. We determined whether eligible patients were offered vaccination and whether patients received vaccination. Barriers to vaccination were determined by a follow-up telephone interview.

RESULTS:
HAV and HBV serologic testing prior to referral and at the liver clinic were performed in 14.5% and 17.7%; and 76.7% and 74% patients, respectively. Hepatologists recommended vaccination for HAV in 63% and for HBV in 59.7% of eligible patients. Patient demographics or disease etiology did not influence recommendation rates. Significant variability was observed in vaccination recommendation amongst individual providers (30-98.6%), which did not correlate with the number of patients seen by each physician. Vaccination recommendation rates were not different for Medicare patients with hepatitis C infection for whom a vaccination reminder was automatically generated by the EHR. Most patients who failed to get vaccination after recommendation offered no specific reason for noncompliance; insurance was a barrier in a minority.

CONCLUSIONS:
Hepatitis vaccination rates were suboptimal even in an academic, sub-speciality setting, with wide-variability in provider adherence to vaccination guidelines.

PLoS One. 2013 Jul 26;8(7):e71124. doi: 10.1371/journal.pone.0071124. Print 2013.

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