gms | German Medical Science

Background: Vaccination is one of the most important measures for primary prevention, control of infectious diseases and for prevention of severe disease progressions and is particularly relevant for patients with oncological diseases due to the increased risk of infection. In international comparison, vaccination rates in Germany are low, especially for adult vaccinations: For influenza, the global WHO vaccination rate is 75% - in Germany this target is clearly missed every year [1]. Although there are effective vaccines and, especially for high-risk groups, detailed recommendations from the Standing Committee on Vaccination (STIKO) [2], the vaccination rates are inadequate, especially in the group of at-risk patients: The vaccination rates for pneumococcal vaccinations may be mentioned as an example. In 2021, vaccination rates continued to fall significantly compared to the previous year despite low vaccination rates ([3], Pfizer according to GKV claims data from Insight Health). Although pharmacies are now allowed to vaccinate against influenza and, for a limited time, against COVID-19 [4], and thus a low-threshold, additional vaccination offer has been created, the issue of "vaccination" with a review of the vaccination status and completion of recommended vaccinations in outpatient and inpatient routine care in hospitals has not been established to date. The aim of this study is to assess structures and barriers and to develop room to maneuver for implementing vaccinations in oncological patient setting with a focus on the complex hospital environment.

Materials and Methods: In 2021, Pfizer cooperated with the VITIS Healthcare Group to develop the concept for a pilot project to be implemented by the VITIS Healthcare Group with the support of the Department I of Internal Medicine at the University Hospital Cologne. As part of a qualitative survey, the status quo was first determined in order to analyze the structure, organization and processes as well as economic aspects in a second step with regard to the possibilities of a targeted vaccination management. Various treatment pathways of oncological diseases were also considered by the medical experts in order to identify potential factors contained therein, but also limits for implementation of vaccinations in the respective setting. Thus, inter alia, points in time within treatment pathways which might be suitable for carrying out vaccinations were ascertained, e.g., differences between tumor types, tumor stages and urgency of treatment.

Results: The analysis revealed insights into potential in-hospital processes regarding integration, administration and refundability of vaccines in hospitals. A vaccination offer does currently not represent a service in the hospital, and the routine check of vaccination status is hardly established. Knowledge and awareness of currently recommended vaccinations in hospitals currently depend on the involvement of individual physicians and departments and are not broadly available in healthcare professionals. The DRG system does not adequately regulate the reimbursement of vaccines and vaccination services. The results will be used for planning and forthcoming implementation of a detailed training concept in the clinical setting and can provide a framework for the development of a best practice model for vaccinations in general health care.

Conclusion: The results show that already established structures in clinical care could be used to improve vaccination status and increase vaccination rates. The interface management between existing expertise, available healthcare professionals and already established therapy paths can be used and optimized for the implementation of vaccinations. A training concept for the implementation of vaccines in the hospital environment can provide comprehensive and timely access to innovative vaccines in the form of a best practice model.

In order to allow vaccinations in hospital settings, a structured training offer for healthcare professionals is currently being developed and implemented as a first step. Both the inpatient oncological department and its outpatient units are taken into account.

Thus, there is a prospect of increasing the overall impact of prevention measures and of relieving healthcare professionals and providers by avoiding vaccine-preventable diseases.