Implementing a public health – hospital care pathway to facilitate vaccination uptake in immunocompromised patients: a regional mixed-methods pilot study

The number of immunocompromised patients (ICPs) is increasing, and these patients are vulnerable to infection and therefore eligible for additional vaccinations. Current guidelines therefore advise vaccination against pneumococcal disease, herpes zoster, and human papillomavirus. However, uptake of these medically indicated vaccines is low, partly due to logistical barriers and limited vaccination facilities. We studied the implementation of a vaccination care pathway for medically indicated vaccines for ICPs, a collaborative initiative between hospitals and municipal public health services (MPHS). The aims were to facilitate vaccine uptake, evaluate collaboration, identify implementation challenges, and determine requirements. A mixed-methods study with a convergent design was conducted, including adult patients with inflammatory bowel disease recruited from two hospitals. Healthcare providers participated in semi-structured interviews, and patients and healthcare professionals completed questionnaires. Vaccination uptake and the quality of consultations were assessed using a predefined scoring checklist. 100 patients were included. Vaccine uptake was high, with 238 of 243 recommended vaccinations administered (97.9%), as was patient satisfaction (mean score 8.6/10). Satisfaction among MPHS providers and gastroenterologists improved during the pilot. Qualitative results showed that a collaborative care pathway is feasible and appreciated. However, challenges included unclear responsibilities, time constraints, variable referral quality, and gastroenterologists’ concerns about long-term maintenance of vaccination expertise within MPHS. Implementation of a collaborative vaccination care pathway for ICPs between hospitals and MPHS is feasible, yielding high satisfaction among both patients and health care providers. Sustainable collaboration requires effective communication, adequate human resources, and supportive organizational structures.