J Clin Outcomes Manage
Low rates of hepatitis A and B vaccination in patients with hapatitis C attending residency clinics
Mangla R, Buntic V, Meighan D, Hale W, Syed M, Atlas SA, Wang Y, Fine JM
Abstract Objective: To evaluate adherence by medical residents to guideline recommendations regarding vaccination of patients with hepatitis C for hepatitis A and B and to determine whether nonvaccinated patients could be recalled to receive vaccines. Methods: We conducted a retrospective chart review for patients seen at 2 teaching hospital–associated internal medicine residency clinics. Demographic and clinical data, including reasons for nonvaccination, were abstracted from medical records. The prospective phase of the study evaluated the success of contacting and vaccinating the nonvaccinated hepatitis C patients. Results: A total of 230 patients were found to be hepatitis C antibody–positive. Clinic nonvaccination rates were equivalent: 80.8% and 82.9% of patients were not vaccinated for hepatitis A, and 75.0% and 87.4% of patients were not vaccinated against hepatitis B. In 70% of cases, there was no reason for nonvaccination recorded in the charts. Multivariate analysis of patient characteristics associated with nonvaccination identified only white ethnicity as a significant risk factor (odds ratio, 0.33 [95% confidence interval, 0.12–0.91]). Attempts to contact 186 nonvaccinated patients were made. 30% of patients were reached, 11% made appointments for vaccination, but only 7% appeared. Conclusion: Adherence to hepatitis A and B vaccination guidelines in patients with chronic hepatitis C followed in residency clinics was low. Failure to discuss vaccination with patients may have played a role. Significant opportunities exist to improve hepatitis vaccination practices in residency clinics serving high-risk patients.
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