HAV and HBV vaccination rates among biopsy‐confirmed NAFL patients in a free access medical system: How can we improve?. Issue 1 (17th February 2020)

• Record Type: Journal Article
• Authors: Liu, Yang; Lee, Howard D.; Morales‐Cardona, Amilcar; Aden, James K.; Paredes, Angelo H.
• Is Part Of: GastroHep. Volume 2:Issue 1(2020)
• Page Start: 31
• Page End: 38
• Publication Date: 2020-02-17
• Subjects: Gastroenterology -- Periodicals; Hepatology -- Periodicals; 616.33
• DOI: 10.1002/ygh2.387
• Languages: English
• ISSNs: 2689-3711

Abstract

Summary: Background: Non‐alcoholic fatty liver (NAFL) is accounting for an increased proportion of chronic liver disease (CLD). These patients have higher risk of complications after acute hepatitis A (HAV) or hepatitis B (HBV) infections, but studies have demonstrated low immunisation rates. Aims: To assess HAV and HBV vaccination rates within a free access treatment facility among those with liver biopsy‐confirmed NAFL and implement quality improvement (QI) measures. Methods: About 371 pre‐QI and 212 post‐QI cohort liver biopsies were examined for quality measures (QM): (a) whether vaccination status was assessed, (b) whether subjects had immunity and (c) whether appropriate recommendation for immunisation was made. QI measures were implemented across two post‐QI plan‐do‐study‐act (PDSA) cycles including: (a) patient‐focused posters; (b) formal presentations to providers; and (c) incorporating HAV/HBV immunisation into the electronic medical record (EMR). Results: For HBV vaccination, in the pre‐QI cohort, 96% met QM#1, 34% met QM#2 and 9% met QM#3. In the first post‐QI cycle, 97% met QM#1, 30% met QM#2 and 30% met QM#3. In the second post‐QI cycle, 97% met QM#1, 37% met QM#2 and 85% met QM#3. For HAV vaccination, in the pre‐QI cohort, 25% met QM#1, 20% met QM#2 and 6% met QM#3. In the first post‐QI cycle, 31% met QM#1, 25% met QM#2 and 21% met QM#3. In the second post‐QI cycle, 52% met QM#1, 42% met QM#2 and 85% met QM#3. Conclusion: Patients with NAFL have low vaccination rates despite having access to free healthcare. Educating patients and both primary care and subspecialty providers on hepatitis vaccination is important and effective.