ABSTRACT

Rheumatologists fail to advise people with RA to get vaccinated but does it matter? An audit in a New Zealand Rheumatology service

Ng BJ¹, McBain L², Grainger R^1
1Department of Rheumatology, Hutt Hospital, 2. Department of General Practice, University of Otago Wellington

Aim: To assess if vaccination against common respiratory pathogens is recommended to people with Rheumatoid Arthritis (RA) in a New Zealand rheumatology service in accordance with guidelines and

determine patient immunisation status for these respiratory pathogens over the preceding five years.

Methods: Retrospective review of electronic health records of all rheumatology outpatient attendances by people with RA at Wellington Regional Rheumatology Unit over a one-month period immediately after release of the 2015 influenza vaccine.

Results: The 232 people with RA in the sample had a mean age of 60.4 years, 40% were over 65 years, 75% were female and 59% had RA duration more than five years. Documented advice for vaccination was infrequent (<5%) at the index visit and other clinically important time points. Despite this, many people were still immunised. A higher proportion of people with RA over the age of 65 received three or more influenza vaccinations in the five-year time period when compared to those under 65 years (X² = 48.183, 1 df, p(exact) < 0.0005). Pneumococcal vaccination rate was low and not influenced by age.

Conclusions: People with RA receive recommended influenza vaccinations despite infrequent advice for vaccination from rheumatology specialist services. Influenza immunisation rate in people with RA, particularly those under 65 years, remains suboptimal and pneumococcal immunisation rates were poor. Multi-level interventions to improve this issue in rheumatology clinics as well as assessment of vaccination advice and administration in other populations with chronic medical co-morbidities is recommended.