title: Understanding vaccination rates and attitudes among patients with rheumatoid arthritis.
abstract: OBJECTIVE
  Appropriate vaccinations are important for patients with rheumatoid arthritis (RA), who are often treated with highly immunosuppressive therapies that increase their risk of infection. However, rates of vaccination among patients with RA are below optimal levels.
  
  
  METHODS
  We conducted a patient survey to assess self-reported vaccination status and to compare that status with electronic health record (EHR) data.
  
  
  METHODS
  We recruited randomly selected patients with RA in an academic practice in 2013. Eligible participants had a diagnosis of RA, at least 1 visit to a rheumatology clinic in each of the previous 2 years, were 18 years or older, and had English listed as their preferred language. The survey included the following domains: a) patient self-reported receipt of influenza, pneumococcal (PNVX), and herpes zoster (HZVX) vaccinations; b) attitudes about these vaccines, including reasons for unvaccinated status, if applicable; and c) provider recommendations about these vaccines.
  
  
  RESULTS
  Based on participants' self-report, we found a high vaccination rate for influenza during the previous season (79.4%), a moderate rate of any previous vaccination for pneumococcus (53.9%), and a very low rate of any previous vaccination for herpes zoster (7.8%). If we assume that all self-reports are accurate and we include vaccinations recorded in the EHR that were not reported by patients, the vaccination rates were approximately 8% to 9% higher for PNVX and HZVX.
  
  
  CONCLUSIONS
  Vaccination rates are low among patients with RA based on self-report data. Further research is needed to investigate system-level barriers to vaccination and the impact of evidence-based, provider-level interventions on vaccination rates.
authors.forename: Diana S
authors.initials: DS
authors.lastname: Sandler
authors.affiliation: Division of Rheumatology, Northwestern University Feinberg School of Medicine, 240 E Huron M300, Chicago, IL 60611. E-mail: e-ruderman@northwestern.edu.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Ruderman
authors.forename: Tiffany
authors.initials: T
authors.lastname: Brown
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Amanda
authors.initials: A
authors.lastname: Mixon
authors.forename: David T
authors.initials: DT
authors.lastname: Liss
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000276:immunology*; D001294:Attitude to Health; D003140:Communicable Disease Control / Q000379:methods / Q000706:statistics & numerical data; D032882:Comprehension; D005260:Female; D022283:Herpesvirus Vaccines / Q000008:administration & dosage; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007252:Influenza Vaccines / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D018570:Risk Assessment; D057566:Self Report; D011795:Surveys and Questionnaires; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D022283:Herpesvirus Vaccines; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines