2026 Southeastern Residency Conference

ADHERENCE TO RECOMMENDED VACCINATIONS IN A VETERAN RHEUMATOLOGY POPULATION: A QUALITY IMPROVEMENT INITIATIVE  
Avery Zapp, Lilian Culp, Whitney White

Birmingham VA Healthcare System – Birmingham, AL


Background/Purpose: This project aimed to systematically evaluate the vaccination status of patients managed by the rheumatology clinic at a Veterans Affairs Medical Center, with a focus on adherence to current immunization guidelines. The interventions also aimed to promote provider engagement and patient awareness. The effectiveness of a multifaceted pharmacist–provider intervention on vaccination rates among veterans was evaluated.
Methodology: Eligible participants include those who are followed in the Birmingham VA rheumatology clinic, currently taking a JAK inhibitor and due for the herpes zoster vaccination. Intervention included pharmacist dashboard monitoring to evaluate patients due for vaccination, with those patients subsequently sent to providers as reminder for their upcoming appointment. Reminder notifications were also sent to eligible patients. Intervention with nursing staff was also performed to address triage and patient education. Vaccination rates in the rheumatology clinic were assessed before and after the interventions were implemented.  
Results: Twenty-nine patients with upcoming appointments were reviewed, all prescribed tofacitinib or upadacitinib. At baseline, 46 percent had at least one documented dose of recombinant zoster vaccine, while 54 percent had no documentation. Most patients (25 of 29) were established in primary care. Overall clinic vaccination rates increased by approximately 1 percent during the study period, with completion of the two‑dose series rising from 41 percent to 42 percent. The primary barriers were patient preference and hesitancy, often related to safety concerns or misperceptions about risk. Documentation gaps, particularly for vaccines administered outside the VA, likely contributed to underestimation of true vaccination status.
Conclusions: Pharmacist‑driven provider reminders and patient outreach efforts improved awareness of vaccination needs but did not produce a substantial increase in herpes zoster vaccination rates during the short study interval. Persistent patient hesitancy and documentation inconsistencies remained barriers to adherence. These findings highlight the need for ongoing, multifaceted strategies - particularly targeted patient education, streamlined documentation processes, and incorporation of additional staff support - to enhance vaccine acceptance in Veterans receiving JAK inhibitors. Future expansion of this initiative will address additional immunization gaps in the rheumatology population.
Presentation Objective: By the end of this presentation, participants will be able to identify key factors affecting herpes zoster vaccination adherence in Veteran rheumatology patients on JAK inhibitors and develop strategies to improve these rates. Self-Assessment: What intervention is most likely to improve recombinant herpes zoster vaccination rates in veterans receiving JAK inhibitors?