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