Authors:- Jilu Jacob, PharmD, BSPK
- Dante M. Grassi, PharmD, BCPS
- Sara Gaines, PharmD, BCPS
- Jennifer Heikkinen, PharmD, BCACP
Learning Objective:Identify opportunities to improve workflow and provider understanding when addressing hepatitis B vaccine care gap notifications.
Self-assessment Questions:True or False: Provider interpretation of hepatitis B vaccine care gap alerts influences whether patients receive appropriate vaccination.
Background:A medication use evaluation was conducted between August 1, 2023 to September 30, 2025 to evaluate the accuracy of hepatitis B vaccine care gaps. This study determined that most inappropriate hepatitis B vaccine care gaps were due to positive serology and of this population, patients received unnecessary vaccinations. As a result, the purpose of this study is to assess barriers to appropriate interpretation of hepatitis B vaccine care gap notifications and identify opportunities for workflow improvement.
Methods:This was a qualitative study conducted through survey and optional interview to current Geisinger primary care providers, nurses and pharmacists involved in the management of hepatitis B vaccine care gap notifications. The survey was dispersed via email and was open from February 23, 2026 to March 26, 2026. A variable question format was used to assess provider interpretation of hepatitis B vaccine care gap notifications, initial response behaviors and possible barriers to appropriate alert management. At the end of the survey, participants were offered the option of a brief follow-up interview to provide additional details on the workflow processes, barriers encountered and suggested strategies for improvement. Data was collected using Microsoft Forms and Microsoft Teams and analyzed qualitatively to identify recurring themes.
Results: The survey was sent to 126 participants, and 27 (21.4%) responses were received. Among providers, 15 (83%) reported first reviewing immunization history when encountering a hepatitis B vaccine care gap notification, while 6 (67%) nurses reported first asking patients about vaccination history. The most common factor determining vaccination appropriateness was documentation of completed vaccination series (59%).
A total of 8 (29.6%) interviews were conducted as a follow-up to the survey. Interview findings showed serologic factors were not commonly incorporated into decision-making with participants primarily focusing on immunization history, outside vaccination records, and patient-reported vaccination history.
Conclusions: Across survey and interviews, immunization history review was the primary factor used when assessing hepatitis B vaccine care gaps. Care gap notification may help guide clinical decision making, but patient specific factors should also be considered. Suppressing alerts in patients with documented immunity along with improving education on vaccine guidelines and serology interpretation may help limit unnecessary vaccinations.
