Via Research Recognition Day 2024 VCOM-Carolinas
Educational Reports
Do Educational Posters Increase First Dose Herpes Zoster Vaccination Rates in a Private Family Practice in Sumter, SC? Alyssa Breedlove, OMS-III; John R. Fleming Jr., MD Edward Via College of Osteopathic Medicine, Carolinas Campus, Spartanburg, SC Magnolia Family Practice, Sumter, SC . Abstract Introduction (cont) Conclusions
Context: The CDC reports that the shingles vaccine rate for adults aged 60 and older in the USA was only 34.5% in 2018. In the US, around 1/3 of adults will develop shingles in their lifetime, even though the recombinant shingles vaccine, Shingrix, is more than 90% effective at preventing shingles after two doses. Objective: To determine if an educational poster in a private practice family medicine clinic exam room will increase the rate of patients choosing to be vaccinated with the Shingrix vaccine. Methods: A retrospective chart review was completed comparing charts of patients for two months prior to the posters being hung and two months with the posters. The posters were provided by Shingrix and contained educational information regarding the benefits of vaccine and potential side effects. Every patient who was seen in the months of June, July, August, and September were included in the chart review, with patients under age 50 and patients being seen for acute, same day appointments being excluded from the chart review. The data was then analyzed using a chi square test. Results: In the months of June and July, 311 patients 50 or older were seen for chronic disease management and preventive health appointments. Of the 311, 23 (7.39%) had previously received at least 1 dose of the recombinant herpes zoster vaccine. Of the 288 that were eligible, 9 (3.13%) received a dose of the vaccine. In August and September, 312 patients were seen, of which 27 (8.65%) had previously received at least one dose of the vaccine. Of the 285 that were eligible, 20 (7.01%) received their first dose. The chi-square test revealed a p-value of 0.034. Conclusions: This quality improvement study performed at Magnolia Family Practice did show a statistically significant increase in the number of patients choosing to receive the herpes zoster vaccine after displaying an educational poster provided by Shingrix in the clinic’s exam rooms with a p-value of 0.034. While previous research shows that educational handouts in clinic waiting rooms don’t help improve vaccine rates, there are numerous other studies that state that provider recommendation is the strongest positive predictor for a patient to receive a vaccine. We believe the improvement shown in this study can be attributed to the placement in the exam room which reminds patients to ask any questions they may have regarding vaccination to their family physician while also reminding the physician to recommend the vaccine during the appointment.
References This quality improvement study performed at Magnolia Family Practice did show a statistically significant increase in the number of patients choosing to receive the first dose of the herpes zoster vaccine after displaying an educational poster provided by Shingrix in the clinic’s exam rooms with a p-value of 0.034. We believe the improvement shown in this study can be attributed to the posters which reminds patients to ask any questions they may have regarding shingles vaccination while also reminding the physician to recommend the vaccine during the appointment. This is in line with previous research on vaccination hesitancy that states that provider recommendation is the strongest predictive factor for a patient to choose to receive a vaccine. Some limitations associated with this study include the payment schedule for vaccines, the lack of a centralized vaccine reporting system for adults, and human error with data collection. Currently, the Shingrix vaccine is covered by most private insurances and by Medicare Part D. Unfortunately, not all patients with Medicare are covered by Part D, so some patients declined vaccination because they would have had to pay out of pocket for the vaccine. We believe universal coverage for the vaccine by all health insurance plans could potentially increase vaccination rates. Another limitation is the lack of a state-wide vaccine tracking software for adults that could help easily and quickly identify if a patient has previously received the HZ vaccine. There is currently a software, SIMON, that allows providers across South Carolina to track pediatric vaccination across practices which could be beneficial to implement for adults. The clinic’s EMR was able to integrate with some other health systems in the area, which provided some insight into vaccination status, but was unable to determine any vaccinations that may have been given elsewhere. This study was a quick, simple intervention that can easily be replicated by other practices in attempt to help improve vaccination rates. The posters were provided by Health Monitor free of charge to the practice. Next Steps: • The clinic is planning to continue displaying the posters in an attempt to increase vaccination rate of its patients • The clinic is pursuing a chart pop-up to remind the physician and medical assistants when the second dose is due • The clinic is attempting to focus on adult vaccinations during preventive health visits, especially Medicare Annual Wellness Visits • The clinic is working to import vaccine records of vaccines received at outside clinics and pharmacies • The clinic is working to bill Medicare directly at the time of vaccination to provide patients with accurate costs for the vaccine in real-time 1. Eiden AL, Barratt J, Nyaku MK. A review of factors influencing vaccination policies and programs for older adults globally. Human Vaccines & Immunotherapeutics . 2023;19(1). doi:10.1080/21645515.2022.2157164 2. Fact sheet: Protect your patients with the new shingles vaccine. Centers for Disease Control and Prevention. July 1, 2019. Accessed November 30, 2023. https://www.cdc.gov/shingles/multimedia/shingles-factsheet-hcp.html. 3. Patil A, Goldust M, Wollina U. Herpes zoster: A review of Clinical Manifestations and management. Viruses . 2022;14(2):192. doi:10.3390/v14020192 4. Singh G, Song S, Choi E, Lee P-B, Nahm FS. Recombinant zoster vaccine (Shingrix): A new option for the Prevention of Herpes Zoster and postherpetic neuralgia. The Korean Journal of Pain . 2020;33(3):201-207. doi:10.3344/kjp.2020.33.3.201 5. Terlizzi EP, Black LI. Shingles vaccination among adults aged 60 and over: United States, 2018. Shingles Vaccination Among Adults Aged 60 and Over: United States, 2018. July 2020. Accessed November 20, 2023. https://www.cdc.gov/nchs/data/databriefs/db370-h.pdf. 6. Zoster (shingles) images. Immunize.org. October 25, 2023. Accessed November 30, 2023. https://www.immunize.org/clinical/image-library/zoster/.
Despite the VZV virus being nearly universal in the US with approximately 99% of people born before 1980 having had varicella at some point in their lives, the CDC reports that the shingles vaccine rate for adults aged 60 and older in the USA was only around 34.5% in 2018. While this is an increase from 6.7% in 2008, there is still room for improvement. In the US, around 1/3 of adults will develop shingles in their lifetime, even though the new recombinant shingles vaccine, Shingrix, is more than 90% effective at preventing shingles after two doses. 2 Previous studies on increasing adult vaccination rates include educational pamphlets in clinic waiting rooms has shown no increase in the vaccination rates for adults. However, numerous studies have shown that education by a patient’s primary care provider does increase vaccine rates. 1 Because of this, the authors predict that combining these two efforts will help to increase HZ vaccine rates.
Methods
Image 3: Photo of Health Monitor Shingles Vaccine Poster that is displayed in the clinic exam rooms
Results
Introduction
In the months of June and July, 311 patients matching the inclusion criteria were seen. Of these, 23 (7.39%) had previously received at least one dose of the recombinant herpes zoster vaccine and were thus excluded. Of the remaining 288 that were eligible, 9 (3.13%) received their first dose of the vaccine and 279 (96.87%) remained unvaccinated. In August and September, 312 patients were seen, of which 27 (8.65%) had previously received at least one dose of the vaccine and were thus excluded. Of the remaining 285 that were eligible, 20 (7.01%) received their first dose and 265 (92.99%) remained unvaccinated. A chi-square test analysis of this difference revealed a p-value of 0.034.
Shingles is caused by the Varicella-zoster virus (VZV), or human herpes virus 3, which is the same virus that is responsible for varicella (chickenpox). After primary infection with VZV which presents clinically as varicella, the virus remains latent in the dorsal root ganglia and cranial nerve ganglia. Once reactivated, the virus replicates within neurons and viral particles are shed, resulting in the characteristic dermatomal pattern of inflammation and vesiculation known as shingles. Although rarely fatal, there are many complications associated with shingles that can be difficult for primary care providers to manage, including postherpetic neuralgia (PHN). PHN is an intense, persistent pain lasting for an additional 4-9 weeks in up to 18% of shingles patients that is unfortunately often resistant to medication treatment. 3,5
Image 2: Left sided abdominal papulovesicular rash in dermatomal pattern. 6
Image 1: Right sided papulovesicular rash in dermatomal pattern, consistent with shingles. 6
In 2017, the Advisory Committee on Immunization Practices began recommending that all adults in the US aged 50 or older be vaccinated for Herpes Zoster, which lowered the recommended age from 60. 5 Since 2020, the only commercial vaccine in the United States to prevent against Herpes Zoster is the Shingrix vaccine, with the previous live vaccine, Zostavax, being removed from the market. Shingrix is a non-live adjuvant recombinant herpes zoster vaccine administered intramuscularly in the deltoid for a two-dose series. 4 The second dose can be administered between two and six months after the first dose.
Ǥ
Fig 1: Graph showing the difference in vaccination status before posters were displayed and with posters displayed. Prior to posters being displayed, 9 out of 288 (3.13%) eligible patients chose to be vaccinated with the RHZ vaccine. With posters, 20 out of 285 (7.01%) eligible patients chose to receive their first dose of the RHZ vaccine.
112
2024 Research Recognition Day
Made with FlippingBook - Online Brochure Maker