Hospitalization and interprofessional team management, especially the involvement of a pharmacist, are essential for the vaccination coverage of patients with diabetes.
Preventive care is vital for the population of diabetes patients. Currently, 37.3 million people in the United States have diabetes and 96 million people over the age of 18 have prediabetes.
Vaccines are an important example of primary prevention for these patients. Patients with diabetes have a higher risk of infection, which is associated with greater complications than in healthy individuals.
The most common infections that occur in patients with diabetes are influenza and pneumococcal infections, both of which can be prevented by vaccination. The CDC recommends that patients with diabetes get the flu vaccine annually; Tdap vaccine every 10 years, zoster vaccine at age 50; pneumococcal vaccine once before age 65 and then 2 more doses after age 65; and hepatitis B vaccine before age 60.
A 2019 observational study conducted in France by the Department of Endocrinology-Nutrition-Diabetes at the University Hospital of Montpellier shows that hospitalizations can increase vaccination coverage in diabetic patients. A multivariable logistic regression analysis assessed coverage for the tetanus, Tdap, pneumococcal, flu, and herpes zoster vaccines.
The study observed coverage of 222 hospitalized patients with diabetes from admission to discharge. All patients over 18 years of age with type 1 or 2 diabetes were eligible for the study. The majority of patients (68.5%) had type 2 diabetes.
The medical team divided the patients into 3 units. Unit 1 consisted of a full-time pharmacist who actively participated in the multidisciplinary treatment of patients.
Unit 2 also had a full-time pharmacist; however, the pharmacist was not involved in the patient’s treatment. Unit 3 was the only unit during the week where there was no full-time pharmacist.
A pharmaceutical team member completed a medication reconciliation within 24 hours of hospitalization. A 10-minute questionnaire examined patients’ vaccination coverage and knowledge of current recommendations.
The study found that only 14 of 222 patients had full vaccination coverage at admission for 1 of 3 vaccines. Factors associated with vaccination coverage included female gender, diabetes care with a team of clinical pharmacists, vaccination coverage with the pneumococcal vaccine, and documentation in the medical record.
Ultimately, vaccination coverage increased by 26.7%, 188% and 8.9% for the Tdap, pneumococcal and influenza vaccines, respectively. This showed that high-risk diabetic patients benefited from hospitalizations and medication reviews.
The study indicates that hospital stay in an endocrinology department may improve coverage for patients with diabetes. The study also found that patients had a poor knowledge of the recommended vaccines, which could play a role in their skepticism.
The authors concluded that hospitalization and interprofessional team management, especially the involvement of a pharmacist, are essential for the vaccination coverage of patients with diabetes.
About the author
Karisse Lora is a 2023 PharmD candidate at the University of Connecticut.
Lohan L, Cool C, Viault L, et al. Impact of hospitalization in an endocrinology department on vaccination coverage in people with diabetes: a real-life study. Medicine (Kaunas). 2022;58(2):219. Published 2022 Feb. doi:10.3390/medicine58020219