Recognizing the acute care burdenThe study was important because of the known high rates of ED visits and hospitalizations among SLE patients, Dr. Feldman said in an interview. "We aimed to understand the burden of emergency department visits and hospitalizations among individuals with lupus that may be preventable if individuals received necessary vaccinations. We know that individuals with lupus, especially those on immunosuppressive medications, are susceptible to infections, and we hypothesized that a percentage of severe infections that result in acute care use may be avoidable if vaccinations were routinely provided."
Dr. Feldman said the researchers were somewhat surprised by the low percentage of SLE patients who had billing claims for vaccinations during the baseline period of the analysis. "While our main focus was on acute care use for vaccine-preventable illness, we did try to ascertain vaccine uptake during the baseline period.
"While it is likely that vaccination rates were suboptimal in this population, the percentages observed may be an underestimate due to lack of billing claims for specific vaccines, if, for example, an individual was vaccinated at a place of work or paid out of pocket," she noted.
Increasing rheumatologist involvement"We identified a higher risk of acute care use for vaccine-preventable illnesses among individuals who are Black, compared to White, and a lower risk among individuals with higher versus lower outpatient care utilization," Dr. Feldman said. "With the known disparities in care and outcomes among individuals with lupus, further efforts are needed to improve access to high-quality outpatient care for the most vulnerable populations.
"Recommendations for vaccinations should be a routine part of care for SLE patients, and increasingly, this is the case. Efforts are being made to incorporate alerts and reminders in electronic medical record systems, which may help increase vaccine uptake," she added.
"Over the study period [2000-2010], we observed a decrease in the incidence of acute care use for vaccine-preventable illnesses, and I suspect that rates have continued to decrease since then," Dr. Feldman said. "Rheumatologists have increased their efforts over the last several years to develop quality improvement initiatives to increase influenza and pneumococcal vaccine uptake. However, other vaccinations that are not routinely provided to all patients and may be less readily available in a rheumatology clinic, such as the HPV and hepatitis B vaccines, still require additional efforts. We certainly know that disparities still exist by race/ethnicity and by socioeconomic status, and work is still needed to ensure that the most vulnerable patients have access to essential preventive care."
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