587. An Intervention to Improve COVID-19 Vaccination Rates Among Inpatients at a Veterans Affairs Hospital

Abstract Background Hospitalizations are an opportunity to increase vaccine uptake and hospital-based strategies have been effective at increasing influenza and pneumococcal vaccination. Offering COVID-19 vaccination at discharge can reduce barriers to vaccination and target patients at high risk for severe illness and death. We evaluated a COVID-19 vaccine intervention implemented as part of routine discharge planning. Methods We trained healthcare personnel during April 2021 to review and document vaccine eligibility and interest for adult inpatients on medical, surgical, or psychiatric wards at the Atlanta VA Medical Center during discharge planning using a templated note in the electronic medical record (EMR). Outpatient vaccination center personnel were deployed to the participating wards daily (except Sundays) to facilitate vaccine administration at discharge. We measured the percentage of discharged patients with vaccine eligibility documented using the template and compared the number of patients vaccinated at discharge in the 4 weeks pre- and post-training. All Georgia adults became eligible for COVID-19 vaccines on March 25, 2021, prior to our intervention. Results Of the 769 patients discharged from one of the participating wards during the 4-week post-training, 474 (62%) had vaccine eligibility documented (Table 1). Of the 474 patients with documentation, 88 (19%) were eligible. Reasons for ineligibility included prior vaccination (n=266, 69%), patient refusal (n=103, 27%), and acute COVID infection (n=12, 3%). Of the 88 eligible patients, 61 (69%) received vaccination before discharge. In total, 16 of 793 inpatients in the pre-training period and 61 of 769 in the post-training period (2% vs 8%; p< 0.05) were vaccinated prior to discharge. Table 1. COVID-19 vaccine eligibility and vaccination before discharge during the post-training period, reported by week Conclusion We found relatively high and sustained uptake of an intervention to screen hospitalized patients for COVID-19 vaccination eligibility. Creating a templated note in the EMR resulted in vaccination of nearly 70% of eligible patients prior to hospital discharge. Disclosures All Authors: No reported disclosures

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Voluntary to Mandatory: Evolution of Strategies and Attitudes toward Influenza Vaccination of Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/663210 ◽

2012 ◽

Vol 33 (1) ◽

pp. 63-70 ◽

Cited By ~ 46

Author(s):

Kathleen Quan ◽

David M. Tehrani ◽

Linda Dickey ◽

Eugene Spiritus ◽

Denise Hizon ◽

...

Keyword(s):

Influenza Vaccination ◽

Vaccination Campaign ◽

Vaccine Uptake ◽

Healthcare Personnel ◽

Vaccination Policy ◽

Vaccination Rates ◽

Hospital Policies ◽

Mandatory Vaccination ◽

Vaccination Campaigns ◽

The Impact

Background.Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.Objective.To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination.Design.Retrospective cohort study.Methods.We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during die 2006–2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected.Results.HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of die surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.Conclusions.A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of die vaccine but who have not made vaccination a priority.Infect Control Hosp Epidemiol 2012;33(1):63-70

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A Model of Bed Demand to Facilitate the Implementation of Data-driven Recommendations for COVID-19 Capacity Management

10.21203/rs.3.rs-31953/v1 ◽

2020 ◽

Author(s):

Teng Zhang ◽

Kelly McFarlane ◽

Jacqueline Vallon ◽

Linying Yang ◽

Jin Xie ◽

...

Keyword(s):

Intensive Care ◽

Acute Care ◽

Capacity Planning ◽

Medical Center ◽

Capacity Management ◽

Data Driven ◽

Severe Illness ◽

Hospital Capacity ◽

Medicine Service ◽

Number Of Patients

Abstract Background:We sought to build an accessible interactive model that could facilitate hospital capacity planning in the presence of significant uncertainty about the proportion of the population that is positive forcoronavirus disease 2019 (COVID-19) and the rate at which COVID-19 is spreading in the population. Our goal was to facilitate the implementation of data-driven recommendations for capacity management with a transparent mathematical simulation designed to answer the specific, local questions hospital leadership considered critical.Methods:The model facilitates hospital planning with estimates of the number of Intensive Care (IC) beds, Acute Care (AC) beds, and ventilators necessary to accommodate patients who require hospitalization for COVID-19 and how these compare to the available resources. Inputs to the model include estimates of the characteristics of the patient population and hospital capacity. We deployed this model as an interactive online tool with modifiable parameters.Results:The use of the model is illustrated by estimating the demand generated by COVID-19+ arrivals for a hypothetical acute care medical center. The model calculated that the number of patients requiring an IC bed would equal the number of IC beds on Day 23, the number of patients requiring a ventilator would equal the number of ventilators available on Day 27, and the number of patients requiring an AC bed and coverage by the Medicine Service would equal the capacity of the Medicine service on Day 21. The model was used to inform COVID-19 planning and decision-making, including Intensive Care Unit (ICU) staffing and ventilator procurement.Conclusion:In response to the COVID-19 epidemic, hospitals must understand their current and future capacity to care for patients with severe illness. While there is significant uncertainty around the parameters used to develop this model, the analysis is based on transparent logic and starts from observed data to provide a robust basis of projections for hospital managers. The model demonstrates the need and provides an approach to address critical questions about staffing patterns for IC and AC, and equipment capacity such as ventilators.Contributions to the literature:· Generation and implementation of data-driven recommendations for hospital capacity management early in the COVID-19 pandemic· The conceptualization, development, and deployment of an interactive simulation model in two weeks· Data-driven capacity management in the presence of significant uncertainty about the expected volume of patients, their clinical needs, and the availability of the workforceTrial Registration: Not applicable

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Barriers to Vaccination Among People with Parkinson’s Disease and Implications for COVID-19

Journal of Parkinson s Disease ◽

10.3233/jpd-202497 ◽

2021 ◽

pp. 1-9

Author(s):

Tiffany Phanhdone ◽

Patrick Drummond ◽

Talia Meisel ◽

Naomi Friede ◽

Alessandro Di Rocco ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Healthcare Utilization ◽

Pneumococcal Vaccination ◽

Emergency Department Visits ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Group Differences ◽

Vaccination Rates ◽

Vaccine Recommendations

Background: Patients with Parkinson’s disease (PD) are at higher risk of vaccine-preventable respiratory infections. However, advanced, homebound individuals may have less access to vaccinations. In light of COVID-19, understanding barriers to vaccination in PD may inform strategies to increase vaccine uptake. Objective: To identify influenza and pneumococcal vaccination rates, including barriers and facilitators to vaccination, among homebound and ambulatory individuals with PD and related disorders. Methods: Cross-sectional US-based study among individuals with PD, aged > 65 years, stratified as homebound or ambulatory. Participants completed semi-structured interviews on vaccination rates and barriers, and healthcare utilization. Results: Among 143 participants, 9.8% had missed all influenza vaccinations in the past 5 years, and 32.2% lacked any pneumococcal vaccination, with no between-group differences. Homebound participants (n = 41) reported difficulty traveling to clinic (p < 0.01) as a vaccination barrier, and despite similar outpatient visit frequencies, had more frequent emergency department visits (31.7% vs. 9.8%, p < 0.01) and hospitalizations (14.6% vs. 2.9%, p = 0.03). Vaccine hesitancy was reported in 35% of participants, vaccine refusal in 19%, and 13.3% reported unvaccinated household members, with no between-group differences. Nearly 13% thought providers recommended against vaccines for PD patients, and 31.5% were unsure of vaccine recommendations in PD. Conclusion: Among a sample of homebound and ambulatory people with PD, many lack age-appropriate immunizations despite ample healthcare utilization. Many participants were unsure whether healthcare providers recommend vaccinations for people with PD. In light of COVID-19, neurologist reinforcement that vaccinations are indicated, safe, and recommended may be beneficial.

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Pneumococcal Vaccination (PCV13) Prior to Initiation of Immunosuppressive Therapy in Patients with Hematological Malignancies Is Associated with Decrease Morbidity and Decrease Hospitalizations

Blood ◽

10.1182/blood-2018-99-118483 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5919-5919

Author(s):

Regina Draliuk ◽

Iveta Mintsman ◽

Alla Shnaider ◽

Shuras Viky ◽

Rotem Benami ◽

...

Keyword(s):

Immunosuppressive Therapy ◽

Intervention Program ◽

Conflicts Of Interest ◽

Blood Stream Infection ◽

Medical Center ◽

Pneumococcal Vaccination ◽

Standard Operating Procedure ◽

Improvement Project ◽

Number Of Patients ◽

The Creation

Abstract Introduction: Pneumococcus is a common bacterium that can cause serious infections, such as pneumonia, meningitis or blood stream infection in patients receiving immunosuppressive therapy. Infection by pneumococcus bacteria can be life-threatening leading to hospitalizations, complications and even death. In this work we have established a system base intervention that provides pneumococcal vaccine (Prevenar 13) for patients before starting chemotherapy and/or biological treatment. Methods: The intervention program included a set of measures: 1. Standard operating procedure (SOP) for vaccination of patients with hematological disorders. 2. Increasing the awareness of the medical and nursing staff regarding the importance of administering the vaccine before chemotherapy/biological treatments. 3. Purchasing vaccines by the hospital. 4.Coaching patients about the importance of receiving the vaccine before starting treatment. 5. Building a computerized record for monitoring and controlling the administration of the vaccine before starting treatment. 6. Transferring the information about the vaccine to the patient outpatient providers. 7. Documentation of the vaccine in the patient's electronic medical record. 8. Monthly review of new patients and vaccination before starting treatment. Results: In 2015, before intervention, only about 25% of patients were vaccinated appropriately against pneumococcus. With the start of the quality improvement project in April 2016, there was a gradual increase in the number of vaccinated patient before starting treatment. In December 2016, all new patients before starting treatment were properly vaccinated against pneumococcus. Although there was a significant increase in the number of patients at the institute in 2017 there was a 35% decrease in the number of patients hospitalized for pneumonia or sepsis compared to 2015. In addition, there was a 41% decrease in the number of hospitalizations with pneumonia or sepsis in the institute's patients. There was also a significant trend towards decrease in mortality (11% vs. 7%). Conclusions: The intervention program included: The creation of cooperation at several levels, medical, nursing and pharmacological that created cooperation between the medical center and the outpatient community clinics which led to the creation of a system that ensures that the patient will be vaccinated prior to starting immunosuppressive therapy. As a result of the intervention at the Institute and the data that was examined over 3 years, there has been a significant decrease in the rate of hospitalizations of patients due to pneumonia or sepsis. Disclosures No relevant conflicts of interest to declare.

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Increasing Pneumococcal Vaccination Rates Among Hospitalized Patients

Infection Control and Hospital Epidemiology ◽

10.1086/502240 ◽

2003 ◽

Vol 24 (7) ◽

pp. 526-531 ◽

Cited By ~ 20

Author(s):

Mary Patricia Nowalk ◽

Donald B. Middleton ◽

Richard K. Zimmerman ◽

Mary M. Hess ◽

Susan J. Skledar ◽

...

Keyword(s):

Nursing Staff ◽

Medical Center ◽

Pneumococcal Infection ◽

Pneumococcal Vaccination ◽

Vaccination Status ◽

Quality Improvements ◽

Post Intervention ◽

Record Keeping ◽

Vaccination Rates ◽

Standing Order

AbstractObjective:To increase the proportion of inpatients vaccinated against pneumococcal infection.Design:Pre- and post-intervention study.Setting:University medical center–affiliated, suburban community teaching hospital.Patients:Unvaccinated inpatients 65 years and older and those 2 to 64 years old who had chronic medical conditions predisposing them to invasive pneumococcal infection.Intervention:The nursing staff screened newly admitted patients for eligibility based on age, diagnosis, or medications from a computer-generated admissions list and placed a pre-printed order form for the pneumococcal polysaccharide vaccine (PPV) on the charts of eligible patients. Following the physician's order, the nursing staff administered the PPV and recorded it. Ongoing quality improvements including admission vaccination screening and computer-based record keeping were initiated to identify unvaccinated eligible patients and track vaccination status.Results:Efforts resulted in rates of in-hospital vaccination ranging from 3.1% to 7.9% (mean, 5.2% ± 1.7% [standard deviation]) and significant improvements in the assessment of previous vaccination status, reaching 54% of eligible patients after 1 year. Ascertainment of a previous vaccination increased significantly following the initiation of the use of admission forms that specifically assessed vaccination status and a system to permanently record vaccination status in an electronic medical record (P < .05).Conclusion:Concerted efforts using electronic medical records significantly improved the assessment and documentation of inpatient vaccination status. Greater improvement of the rates of in-hospital vaccination will require healthcare system–wide efforts such as a standing order policy for vaccinating all eligible patients. Standing orders for inpatient immunization supported by effective assessment and tracking systems have the potential to raise vaccination rates to the goals of Healthy People 2010 (Infect Control Hosp Epidemiol 2003;24:526-531)

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Overcoming Barriers to Establishing an Inpatient Vaccination Program for Pneumococcus Using Standing Orders

Infection Control and Hospital Epidemiology ◽

10.1086/502511 ◽

2005 ◽

Vol 26 (11) ◽

pp. 874-881 ◽

Cited By ~ 17

Author(s):

Donald B. Middleton ◽

Dwight E. Fox ◽

Mary Patricia Nowalk ◽

Susan J. Skledar ◽

Denise R. Sokos ◽

...

Keyword(s):

Medical Center ◽

Tertiary Care ◽

Pneumococcal Vaccination ◽

Vaccination Rate ◽

Vaccination Program ◽

Successful Implementation ◽

Close Monitoring ◽

University Of Pittsburgh ◽

Vaccination Rates ◽

The University

AbstractObjectives:To identify and classify barriers to establishing a standing orders program (SOP) for adult pneumococcal vaccination in acute care inpatient facilities and to provide recommendations for overcoming these roadblocks. Vaccination rates in hospitals with SOPs are generally higher than those in hospitals that require individual physician orders. The array of solutions drawn from our experience in different hospital settings should permit many types of facilities to anticipate and overcome barriers, allowing a smoother transition from initiation to successful implementation of an inpatient pneumococcal vaccination SOP.Design:Descriptive study of barriers and solutions encountered during implementation of a pneumococcal vaccination SOP in three hospitals of the University of Pittsburgh Medical Center Health System (UPMC) and in the scientific literature.Setting:As of 2004, two UPMC tertiary-care hospitals and one UPMC community hospital had incorporated SOPs into existing physician order-driven programs for inpatient vaccination with pneumococcal polysaccharide vaccine.Results:Barriers were identified at each step of implementation and categorized as patient related, provider related, or institutional. Based on a process of continual review and revision of our programs in response to encountered barriers, steps were taken to overcome these impediments.Conclusions:A strong commitment by key individuals in the facility's administration including a physician champion; ongoing, persistent efforts to educate and train staff; and close monitoring of the vaccination rate were essential for successful implementation of a SOP for pneumococcal vaccination of eligible inpatients. Legal statutes and evaluations of external hospital-rating associations regarding the effectiveness of the vaccination program were major motivating factors in its success.

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A Quality Improvement Project to Improve Influenza Vaccination Rates Among Employees at an Onsite Employer-Based Health Clinic

Workplace Health & Safety ◽

10.1177/21650799211016906 ◽

2021 ◽

pp. 216507992110169

Author(s):

Karen Landwehr ◽

W. Jeff Trees ◽

Susan Reutman

Keyword(s):

Quality Improvement ◽

The United States ◽

Quality Improvement Project ◽

Vaccine Uptake ◽

Health Clinic ◽

Full Time ◽

Improvement Project ◽

Vaccination Rates ◽

Number Of Patients ◽

Flu Vaccine

Background In the United States, millions of people contract the flu each year. Immunization has been shown to provide the best protection against the flu. Increasing flu vaccination rates can reduce the number of patients who get the flu and seek care for non-specific symptoms thus making detection of the coronavirus more efficient. Method A quality improvement project was implemented to increase the number of influenza vaccines received by employees at an onsite employer-based health clinic. Anonymous pre- and post-surveys were used to assess the flu knowledge of employees. Employees from a large financial group, who voluntarily participated, received an educational handout at the onsite health fair or at a lunch and learn. Full-time employees who carried their employer’s health insurance were eligible to participate, whereas, dependents and contract employees were excluded. Findings The number of employees who received the vaccination increased during the fall of 2019 ( n = 406) when compared with the previous year ( n = 337). Nineteen percent ( n = 170) of employees completed surveys. There were statistically significantly more post- than pre-survey responses reflecting the participants’ perceived knowledge of influenza and the flu vaccine. The majority of participants in both the pre- and post-surveys reported that they learned “a lot” about both influenza and the flu vaccine. Conclusion Providing education and access to the vaccine in the workplace may improve flu knowledge, reduce barriers, and increase flu vaccine uptake among employees.

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Using Participatory Action Research to Identify Strategies to Improve Pandemic Vaccination

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2013.72 ◽

2013 ◽

Vol 7 (4) ◽

pp. 424-430 ◽

Cited By ~ 1

Author(s):

Kathleen A. Crowley ◽

Ronnie Myers ◽

Halley E.M. Riley ◽

Stephen S. Morse ◽

Paul Brandt-Rauf ◽

...

Keyword(s):

Action Research ◽

Influenza Vaccination ◽

Participatory Action Research ◽

Medical Center ◽

Low Cost ◽

Vaccine Uptake ◽

Organizational Strategies ◽

Front Line ◽

Participatory Action ◽

Vaccination Rates

AbstractObjectiveDeveloping and implementing effective strategies to increase influenza vaccination rates among health care personnel is an ongoing challenge, especially during a pandemic. We used participatory action research (PAR) methodology to identify targeted vaccination interventions that could potentially improve vaccine uptake in a medical center.MethodsFront-line medical center personnel were recruited to participate in 2 PAR teams (clinical and nonclinical staff). Data from a recent medical center survey on barriers and facilitators to influenza (seasonal, pandemic, and combination) vaccine uptake were reviewed, and strategies to increase vaccination rates among medical center personnel were identified.ResultsFeasible, creative, and low-cost interventions were identified, including organizational strategies that differed from investigator-identified interventions. The recommended strategies also differed by team. The nonclinical team suggested programs focused on dispelling vaccination-related myths, and the clinical team suggested campaigns emphasizing the importance of vaccination to protect patients.ConclusionsPAR methodology was useful to identify innovative and targeted recommendations for increasing vaccine uptake. By involving representative front-line workers, PAR may help medical centers improve influenza vaccination rates across all work groups. (Disaster Med Public Health Preparedness. 2013;0:1–7)

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Development of a Flexible, Computerized Database to Prioritize, Record, and Report Influenza Vaccination Rates for Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/596043 ◽

2009 ◽

Vol 30 (4) ◽

pp. 361-369 ◽

Cited By ~ 15

Author(s):

Michael Melia ◽

Sarah O'Neill ◽

Sherry Calderon ◽

Sandra Hewitt ◽

Kelly Orlando ◽

...

Keyword(s):

Influenza Vaccination ◽

Patient Care ◽

Medical Center ◽

Tertiary Care ◽

The United States ◽

Healthcare Personnel ◽

Direct Patient Care ◽

Vaccination Rates ◽

Tertiary Care Medical Center ◽

The Status

Objective.To describe the method used to develop a flexible, computerized database for recording and reporting rates of influenza vaccination among healthcare personnel who were classified by their individual levels (hereafter, “tiers”) of direct patient contact.Design.Three-year descriptive summary.Setting.Large, academic, tertiary care medical center in the United States.Participants.All of the medical center's healthcare personnel.Methods.The need to develop a computer-based system to record direct patient care tiers and vaccination data for healthcare personnel was identified. A plan that was to be implemented in stages over several seasons was developed.Results.Direct patient care tiers were defined by consensus opinion on the basis of the extent, frequency, and intensity of direct contact with patients. The definitions of these tiers evolved over 3 seasons. Direct patient care classifications were assigned and recorded in a computerized database, and data regarding the receipt of vaccination were tracked by using the same database. Data were extracted to generate reports of individual, departmental, and institutional vaccination rates, both overall and according to direct patient care tiers.Conclusions.Development of a computerized database to record direct patient care tiers for individual healthcare workers is a daunting but manageable task. Widespread use of these direct patient care definitions will facilitate uniform comparisons of vaccination rates between institutions. This computerized database can easily be used by infection control personnel to accomplish several other key tasks, including vaccination triage in the context of shortage or delay, prioritization of personnel to receive interventions in times of crisis, and monitoring the status of other employee health or occupational health measures.

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Suboptimal Immunization Coverage among Canadian Rheumatology Patients in Routine Clinical Care

The Journal of Rheumatology ◽

10.3899/jrheum.181376 ◽

2019 ◽

Vol 47 (5) ◽

pp. 770-778 ◽

Cited By ~ 6

Author(s):

Tedi Qendro ◽

María Laura de la Torre ◽

Pantelis Panopalis ◽

Elizabeth Hazel ◽

Brian J. Ward ◽

...

Keyword(s):

General Population ◽

Clinical Care ◽

Pneumococcal Vaccination ◽

Immunization Coverage ◽

Vaccine Uptake ◽

Physician Education ◽

Physician Recommendation ◽

Vaccination Rates ◽

Routine Clinical Care ◽

Treatment Type

Objective.To assess vaccination coverage and predictors of vaccination among a Canadian population of rheumatology patients in routine clinical care.Methods.In this cross-sectional study, consecutive adult patients presenting to a tertiary rheumatology clinic at the McGill University Health Center between May and September 2015 were asked to fill a survey on vaccination. Patients self-identified as having rheumatoid arthritis (RA), systemic autoimmune rheumatic diseases (SARD), spondyloarthropathies (SpA), or other diseases (OD). Multivariate logistical regression analyses were performed to evaluate patient and physician factors associated with various vaccinations [for influenza, pneumococcus, and hepatitis B virus (HBV)]. Published Quebec general population influenza and pneumococcal vaccination rates in those aged ≥ 65 years were used as comparative baseline rates.Results.Three hundred fifty-two patients were included in the analysis (RA: 136, SARD: 113, SpA: 47, OD: 56). Vaccination rates were reported as follows: (1) influenza: RA 48.5%, SARD 42.0%, SpA 31.9%, OD 88.9%, Quebec general population 58.5%; (2) pneumococcal: RA 42.0%, SARD 37.8%, SpA 29.7%, OD 33.3%, Quebec general population 53.2%; (3) HBV: RA 33.6%, SARD 55.6%, SpA 73.5%, OD 36.8%; and (4) herpes zoster: RA 5.6%, SARD 28.6%, SpA 25.0%, OD 16.7%. Physician recommendation was the strongest independent predictor of vaccination across all vaccine types (influenza: OR 8.56, 95% CI 2.80–26.2, p < 0.001; pneumococcal: OR 314, 95% CI 73.0–1353, p < 0.001; HBV: OR 12.8, 95% CI 5.27–31.1, p < 0.001). Disease group, disease duration, comorbidities, treatment type, and being followed by a primary care physician were not significantly associated with vaccination.Conclusion.There is suboptimal immunization coverage among ambulatory rheumatology patients. An important role for patient and physician education is highlighted in our study, especially because physician recommendation of vaccination was strongly predictive of vaccine uptake.

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