A virtual clinic improves pneumococcal vaccination coverage among patients living with HIV at a Veterans Affairs Medical Center

ABSTRACT

People living with the human immunodeficiency virus (HIV) should receive pneumococcal vaccinations as part of their routine health maintenance. Our goal was to create a “virtual clinic” to help increase rates of pneumococcal vaccination among people living with HIV without adding substantially to the workload of primary providers. We used administrative data from our Veterans Affairs (VA) medical center to identify a cohort of veterans living with HIV who were not current with either the 13-valent pneumococcal conjugate vaccine (PCV13), the 23-valent pneumococcal polysaccharide vaccine (PPSV23) or both. We enrolled these individuals (n = 99) into a virtual clinic, notified providers via the electronic medical record and mailed letters to the veterans recommending they receive a pneumococcal vaccine. We also wrote orders for the appropriate pneumococcal vaccine that expired after 90 days. Among the virtual clinic cohort, 38% (38/99) of patients received the recommended vaccine within 180 days. Concurrent with our intervention, the Veterans Health Administration deployed a system-wide pneumococcal vaccine clinical reminder that incorporated recent PCV13 recommendations. To discern any effect of the virtual clinic beyond that of the clinical reminder, we compared the rate of PCV13 vaccinations among all HIV-positive veterans at our institution to the equivalent population from 2 other VA medical centers in Ohio. With consideration of the VHA’s system-wide clinical reminder, the proportion of HIV-positive patients who received PCV13 in the first 90 days following the virtual clinic intervention was greater at our facility compared to another Ohio VA medical center (P < 0.05). The virtual clinic improved the pneumococcal vaccine coverage among HIV-positive veterans. These outcomes suggest that even in conjunction with a system-wide clinical reminder, the virtual clinic strategy improves vaccination rates among a high-risk population.

KEYWORDS:

• Human immunodeficiency virus
• immunization
• pneumococcal vaccines
• 13-valent pneumococcal vaccines
• 23-valent pneumococcal capsular polysaccharide vaccine
• electronic health record

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by an educational grant from Pfizer (RJ, FP). This study was also supported in part by funds and facilities provided by the Geriatric Research Education and Clinical Center (GRECC) and Specialty Care Center of Innovation at the Cleveland Department of Veteran Affairs (VA) (FP, RB, BW, RJ) and from the National Institutes of Health (NIH), through the Clinical and Translational Science Collaborative of Cleveland (UL1TR000439) from the National Center for Advancing Translational Sciences (NCATS) component of the NIH and NIH Roadmap for Medical Research (FP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Department of Veterans Affairs, the NIH or the United States Government.