A Clinical Audit of Vaccination in Patients Living with Inflammatory Arthritis and Receiving Specialty Medications
Bibliographic record
Abstract
Objectives Both ACR and EULAR recommend appropriate vaccination for patients with inflammatory arthritis due to their higher risk of vaccine-preventable illness (VPI).[1,2] Immunosuppressive therapies may further increase VPI risk. Understanding baseline vaccination rates is crucial for implementing targeted quality improvement strategies. Methods A chart review was performed on South Health Campus Rheumatology Clinic patients who were a) seen between January 1, 2023, and January 1, 2024, b) over the age of 18, c) diagnosed with inflammatory arthritis (RA, PsA, AS, SpA, etc.), and d) were taking either biologic or JAK inhibitor pharmacotherapy. Vaccinations against influenza, COVID-19, pneumonia (Prevnar 13/20, Pneumovax-23), and shingles (Shingrix) were reviewed. Both physicians and stable nurse clinics patients were included. Descriptive statistics were performed for data analysis. Results 216 patient charts were audited (Figure 1). We found that 97% (210/216) of patients had a recommendation for updating or achieving full vaccination noted in their rheumatology consult notes. 53.2% of patients (115/216) received annual influenza vaccine, with 66.6% (64/96) in nurse clinics vs 42.5% (51/120) in physician clinics. 64.6% (73/113) of patients >65 received this vaccination c.f. 40.6% (41/101) <65. 69.9% of patients received > 3 mRNA COVID vaccines with 79.2% (76/96) of vaccinations in nurse clinics vs 42.5% (75/120) in physician clinics. 84.1% (95/113) of patients age >65 received vaccination c.f. 54.4% (55/101) <65. 55.5% of patients received Prevnar 13 or 20: 68.7% (66/96) in nurse clinics vs 45% (54/120) in physician clinics. 63.7% (72/113) of patients age >65 received vaccination c.f. 45.5% (46/101) of patients <65. 68.5% of patients received Pneumovax-23: 81.2% (78/96) in nurse clinics vs 58.3% (70/120) in physician clinics. 89.4% (72/113) of patients age >65 received vaccination c.f. 45.5% (46/101) <65. 28.7% of patients received Shingrix: 36.4% (35/96) in nurse clinics vs 17.5% (27/120) in physician clinics. 35.4% (40/113) of patients >age 65 received vaccination c.f. 21.8% (22/101) of patients <65. Conclusion In this audit we found increased vaccination rates in the nurse clinic and among patients > 65 years old. High vaccination rates observed in the nurse clinic likely resulted from dedicated preventative health protocols, clinical stability of nurse clinic patients, and physician/nursing collaboration. Higher rates of >65 vaccination was likely due to increased vaccine receptiveness of older adults, public coverage and outreach programs (programs focusing on vaccination for patients in congregate living), clinic promotion efforts, and community (family physician, pharmacy) promotion of vaccination. [1.] Bass AR. Arthritis Care & Research 2023;75(3):449-64. [2.] Furer V. Ann Rheum Dis 2020;79(1):39-52.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".