title: Hepatitis C performance measure on hepatitis A and B vaccination: missed opportunities?
abstract: OBJECTIVE
  Prevention of hepatitis A virus (HAV) and hepatitis B virus (HBV) infection in patients with chronic hepatitis C (CHC) through vaccination is endorsed by all major professional societies. This study was conducted to determine adherence to the recently adopted physician performance measure on HAV and HBV vaccination.
  
  
  METHODS
  This was a retrospective study. Hepatitis A and B serology data and immunization records between 2000 and 2007 from CHC patients with detectable hepatitis C virus (HCV) RNA were analyzed.
  
  
  RESULTS
  A total of 2,968 CHC patients were included in the study. Of these, 2,143 patients (72%) were tested for susceptibility to HAV, of which 53% had immunity. Of the non-immune patients, 746 (74%) were vaccinated as well as an additional 218 without prior testing. For HBV, 2,303 patients (78%) were tested for immunity and 782 (34%) were immune. Of the susceptible patients, 1,086 (71%) were vaccinated as well as an additional 197 patients without prior testing. The overall vaccination performance measure adherence rate was 71% for HAV, 70% for HBV, and 62% for both HAV and HBV. Random review of 176 charts found the major reasons for non-adherence were missed opportunity (41%), change of health care system (31%), and documented vaccination outside our health care system (22%).
  
  
  CONCLUSIONS
  Our study found a high and improved adherence to the recommendations, but missed opportunity was still the main reason of non-adherence. This study also supported the strategy of selective vaccination in the veteran population.
authors.affiliation: Pharmacy Service, VA Palo Alto Health Care System, Palo Alto, California 94304, USA.
authors.forename: Bridget
authors.initials: B
authors.lastname: Hernandez
authors.forename: Noelle K
authors.initials: NK
authors.lastname: Hasson
authors.forename: Ramsey
authors.initials: R
authors.lastname: Cheung
mesh_terms: D005260:Female; D006506:Hepatitis A / Q000150:complications* / Q000517:prevention & control*; D022362:Hepatitis A Vaccines; D006509:Hepatitis B / Q000150:complications* / Q000517:prevention & control*; D017325:Hepatitis B Vaccines; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines