Revista de Hígado: enfermedades y trasplantes

Improving Viral Hepatitis Vaccination Practices for Cirrhotic Patients in Gastroenterology Fellows’ Clinics Using the Electronic Health Record

Keaton Jones, Taiwo Ngwa , Mustapha El-Halabi , Benjamin Bick , Kunal Dalal  and Nabil Fayad

Abstract Background: Patients with chronic liver disease are at increased risk for morbidity and mortality after superimposed hepatitis A or B virus infections. Historically, providers have done a poor job addressing hepatitis A and B immunity.

Aim: We examined hepatitis A and B immunity in cirrhotic patients within our gastroenterology fellows’ clinic and assessed how electronic medical record prompts could improve vaccination practices.

Methods: Clinical data was extracted manually on all cirrhotic patients seen during pre-intervention and post-intervention periods at two continuity clinic sites examining how often providers addressed vaccine status and ordered vaccines or antibody serologies. A handout with current guideline recommendations and an electronic template for cirrhosis management were given to all providers as the intervention between the two study periods. Statistical analysis was performed comparing pre- and post-intervention data.

Results: Prior to intervention protective antibodies against hepatitis A and B virus were only present in 43% and 19% of patients at site one and 19% and 25% at site two, respectively. Pre- and post-intervention patient demographics were not significantly different. Patients seen post-intervention more consistently had hepatitis A and B vaccination status addressed by providers, having vaccines or antibody serologies ordered significantly more often.

Conclusion: Serious deficiencies exist in ensuring patients with cirrhosis are vaccinated to hepatitis A and B viruses. Handouts and disease specific templates in the medical record can help ensure providers are addressing vaccination status to improve patient care.