Ensuring that patients with chronic obstructive pulmonary disease (COPD) receive vaccines associated with lung infection is critical to caring for these populations.
Findings from a new study show that the referral of patients to a lung clinic was associated with a higher incidence of receiving the flu and pneumococcal flu vaccine.
“Despite the importance of providing guideline-based care, adherence to the recommendations of the Global Initiative for the Prevention of Lung Disease (GOLD) has been non-optical, including pharmacologic therapies and non-pharmacologic, ”wrote the researchers.
The study team, led by Solmaz Ehteshami-Afshar, MD, MSc, Internal Medicine, Yale University School of Medicine, conducted a cross-sectional analysis among COPD patients receiving primary care.
The aim of the study was to determine adherence to vaccines to inform quality improvement targets.
Vaccines and COPD
The study was conducted at one clinical site from January 1, 2018-3 December, 2019, and enrolled patients diagnosed with COPD according to an international classification of disease, the tenth revision codes.
The main outcomes requested by the researchers were vaccines for pneumococcal (PCV13), pneumococcal polysaccharide (PPSV23) and influenza (consecutive from 2017-2019).
“We identified vaccine records for PCV13 and PPSV23 (including pre-test time), flu vaccine records, smoking status (normal, previous, ever), age and gender of patients with a detailed chart review of PC and / or lung text notes from the electronic health record, ”they wrote.
Among 200 patients, the average age was 70.5 years, and half were female.
In addition, 78 patients underwent lung subspecies assessment in the previous 3 years. These patients were more likely to smoke (59%) and had a higher packing year smoking history (48.4 pack years versus 37.7 pack years, respectively; P. = .01).
Among this sub-population, 20.5% were hospitalized for COPD in the previous 12 months – compared to 2.4% in those without a lung subspecies assessment.
Ehteshami-Afshar and colleagues noted that, in patients ≥ 65 years of age, PCV13 and PPSV23 vaccine levels were significantly higher among patients referred to a lung specialist (PCV13: 96.6 % vs. 81.6%, P. = .009; PPSV23: 94.8% vs 84.7%, P. = 0.03).
Compared with patients administered by primary care-only providers, influenza vaccination rates were higher for advanced patients of all ages (2017 = 81%, cited, vs. 63%, unreported; P. = .008; 2018 = 80% vs 62.5%, P.= .008; 2019 = 70.5% vs 52%, P.= 0.011).
These same trends were consistent following multivariate models adjusting according to age, sex, and smoking status.
“Given the very low vaccination rates for pneumococcal and influenza, these findings highlight the importance of developing strategies to comply with COPD guidelines for non-pharmacological care in the PC settings and lung subspecies, ”said investigators.
The team acknowledged that there was uncertainty about whether vaccines were given during pulmonary subarachnoid hemorrhage or a primary care visit.
“It is possible that primary care providers who send patients to the lungs may be more suited to COPD management care,” they wrote.
“Thus, complementary management of COPD with primary care and pulmonology could translate into improved overall COPD care. ”
The study, ‘Does lung transplantation from primary care affect adherence to vaccine recommendations in COPD patients? ”Is published online in Respiratory research.