HAV and HBV vaccination rates among biopsy‐confirmed NAFL patients in a free access medical system: How can we improve?

Background Non-alcoholic fatty liver (NAFL) is accounting for an increased proportion of chronic liver disease (CLD). These patients have higher risk of complications after acute hepatitis A (HAV) or hepatitis B (HBV) infections, but studies have demonstrated low immunisation rates. Aims To assess HAV and HBV vaccination rates within a free access treatment facility among those with liver biopsy-confirmed NAFL and implement quality improvement (QI) measures. Methods About 371 pre-QI and 212 post-QI cohort liver biopsies were examined for quality measures (QM): (a) whether vaccination status was assessed, (b) whether subjects had immunity and (c) whether appropriate recommendation for immunisation was made. QI measures were implemented across two post-QI plan-do-study-act (PDSA) cycles including: (a) patient-focused posters; (b) formal presentations to providers; and (c) incorporating HAV/HBV immunisation into the electronic medical record (EMR). Results For HBV vaccination, in the pre-QI cohort, 96% met QM#1, 34% met QM#2 and 9% met QM#3. In the first post-QI cycle, 97% met QM#1, 30% met QM#2 and 30% met QM#3. In the second post-QI cycle, 97% met QM#1, 37% met QM#2 and 85% met QM#3. For HAV vaccination, in the pre-QI cohort, 25% met QM#1, 20% met QM#2 and 6% met QM#3. In the first post-QI cycle, 31% met QM#1, 25% met QM#2 and 21% met QM#3. In the second post-QI cycle, 52% met QM#1, 42% met QM#2 and 85% met QM#3. Conclusion Patients with NAFL have low vaccination rates despite having access to free healthcare. Educating patients and both primary care and subspecialty providers on hepatitis vaccination is important and effective.