Introduction We describe the implementation of a vaccine initiative in an ambulatory transplant setting.

Methods In 2014, Hahnemann University Hospital (HUH) and Colonia Natural Pharmacy transplant specialty department (Colonia NP), created the VIC, in response to persistently low vaccination rates through other associated providers despite clinical recommendations. Referrals were made to ColoniaNP for pharmacy/medical insurance approval. Following insurance approval, vaccines were delivered to the HUH clinic for administration. Insurance denials resulted in re-directing patients back to primary care physicians for vaccination, re-iterating the necessity. This report focuses on rates of Prevnar-13® (Pneum) and tetanus/pertussis (Tdap) vaccinations.

Results Forty-eight patients (69 vaccines) were enrolled in our HUH/Colonia NP VIC. All patients enrolled were greater than 6 months post-transplant. The cohort consisted of a similar number of male (52%, median age 44.5) vs. female patients (48%, median age 53). The cohort consisted of more kidney transplant only recipients (81%) vs. dual organ transplants (4-6%). Forms of insurance coverage were comparable (public 54% vs. private 46%). Fifty-three (77%) referrals were approved. Rates of insurance approval varied: public 100% vs. private insurance 50%. In some cases insurance approval occurred 30 days after initial referral. Median time from referral to vaccine administration was 83.5 days (range 8 – 183). Chart 1 describes reasons for denial. Of note, 21 patient referrals included both Pneum and Tdap; 14 patients received insurance approval for both vaccinations.

Discussion Assessing vaccine status is widely recognized as a key component of long-term wellness care for transplant recipients. Rates of vaccination remain suboptimal with significant barriers to access. We suggest that transplant centers take an active role in managing their patients' vaccine immunity by partnering with equipped specialty pharmacies. Key barriers include improving patient awareness, referring physician communication, and navigating patient insurance coverage.

CITATION INFORMATION: Malat G, DiLollo S, Lee D, Sharma A, Bias T, Harhay M, Ranganna K, Doyle A. Post-Transplant Vaccine Initiative Collaboration (VIC) in a Multidisciplinary, Transplant Ambulatory Setting. Am J Transplant. 2016;16 (suppl 3).

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