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P594 Systematic information to healthcare professionals about ECCO's vaccination guidelines improves adherence in patients with inflammatory bowel disease receiving anti-TNF α therapy

K. Risager Christensen, C. Steenholdt, S. Schnoor Buhl, M.A. Ainsworth, O. Østergaard Thomsen*, J. Brynskov

Herlev University Hospital, Department of Gastroenterology, Copenhagen, Denmark

Background

The European Crohn's and Colitis Organisation (ECCO) have developed guidelines for prevention of infectious diseases in patients with inflammatory bowel disease (IBD). However, implementation of vaccination routines in an everyday clinical setting is difficult. The aim was to investigate if systematic information to healthcare professionals about screening and vaccination guidelines improves patients' adherence hereto. Furthermore, to identify barriers for adherence to the guideline.

Methods

This study was carried out at a tertiary IBD center and consisted of three parts: 1) A cross-sectional study where baseline vaccination status was assessed in all IBD patients in ongoing anti-TNF α therapy as of March, 2013 (reference group n=130); 2) an intervention study where healthcare professionals received oral and written information about screening and vaccination guidelines every 2 months during a period of 6 months, and followed by assessment of vaccination status in all IBD patients in ongoing anti-TNF α therapy (intervention group n=99); and 3) a survey of Danish gastroenterologists' adherence to, knowledge of, and barriers for adherence to vaccination guidelines (n= 53 physicians from 7 centers). Validated questionnaires were used to assess the outcomes. European Crohn's and Colitis Organisation's (ECCO) guidelines served as gold standard. [1]

Results

Patients' adherence to recommended vaccinations during anti-TNF α therapy increased significantly after the period of systematic information to healthcare professionals about the guidelines. Hence, the percentage of patients completely adherent to all recommended vaccinations increased from only 5% to 26%, partial adherence increased from 38% to 56% and complete non-adherence decreased from 57% to 18% (p<0.0001). Adherence to all individual recommended vaccinations except human papilloma virus increased significantly (p<0.05). Prior to information about guidelines, only 8% of included physicians could identify all the recommended screening and vaccination measurements, and 89% were able to identify at least one recommendation. The most frequently reported patient barriers for adherence were high cost of vaccinations (35%) and forgetfulness (25%). The most frequent barriers reported by physicians were forgetfulness (29%) and insufficient consultation time (22%).

Conclusion

Gastroenterologist's limited knowledge of vaccination guidelines during anti-TNF α therapy can be overcome by systematic education, and this inexpensive and easily accessible intervention immediately results in markedly improved patient adherence. Remaining obstacles for adherence comprise high expenses for vaccinations and patient's forgetfulness.

References:

[1] Rahier et al, (2014), Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease, J Crohns Colitis