Meningococcal Education Program for Quebec Physicians: How Results Have Changed 2 Years after the Initial Program

Transcription

1 Meningococcal Education Program for Quebec Physicians: How Results Have Changed 2 Years after the Initial Program Marc H. Lebel, MD, FRCPC John Yaremko, MD, FRCPC Anne Dionne, MD, FRCPC Anne-Julie Gaudreau, B. Sc., M.Sc.

2 Disclosure Dr Marc Lebel Member of Advisory Board, Grants, Speaker Bureau Novartis Pfizer GlaxoSmithKline Laboratoires Abbott Abbvie

3 Background Invasive meningococcal disease is of importance to public health: epidemic potential and disease burden in children - adolescents IMD is primarily caused by five serogroups : A, B, C, Y, and W135 Incidence rate: highest among children < 1 year of age, declines as age increases, but peaks again in the 15 to 19 year age group With the availability of quadrivalent conjugate vaccines, the development of new vaccines against serogroup B (Men B) as well as recent national guidelines on IMD, paediatricians may not be aware of the changes in IMD epidemiology and prevention, and their application to clinical practice

4 Methods (1) To assess the learning needs of Quebec paediatricians in the area of IMD prevention, a survey of 10 questions was developed in collaboration with l Association des pédiatres du Québec (APQ) and was distributed to 672 paediatricians Based on the results of this online survey, a core scientific committee composed of paediatricians, infectious disease and emergency medicine specialists was created to analyze the results and to develop an accredited CME program that addresses the specific learning needs identified The provincial roll-out of the program was conducted by the APQ and was delivered through interactive live sessions over the fall of 2011 and winter of 2012 in 6 regions across Quebec province Educational non restrictive grant from Novartis

5 Methods (2) A second program was rolled out in 2014 in 4 regions During the interactive sessions participants were subject to pre-intervention questions using touch pad devices that was subsequently re-administered as a post-test to assess the immediate impact on their knowledge of IMD An online adaptation of the IMD educational modules developed is currently available on the APQ website. Results of pre- and post-tests from the online participation have been compared to those obtained from the live sessions Results were also compared between the first and second rollout

6 Results Needs Assessment Survey 95 paediatricians completed the survey Responders were predominantly (79%) general paediatricians, with 21% being sub-specialized 62% of responders were unaware of the need of circulating antibodies to protect against IMD over time Only 20% of responders were aware of the relative proportion of Men B cases in children and adolescents The incidence of serogroup B infections in children and adolescents was unknown to 33% of responders

7 Sample Summary of Online Need Assessment Answer/Percentage of Response Question Yes No Uncertain Most cases of meningococcal disease are caused by 3 serogroups Serogroup B is the most common cause of IMD in Canada A quadrivalent meningococcal vaccine (ACWY) has been introduced in most Canadian public programs Evidence shows the need for circulating antibodies for the prevention of IMD Neisseria meningitidis is most frequent in what age group 63% 26% 11% 75% 14% 11% 21% 57% 22% 60% 10% 30% < 4 years Adolescent > 60 years 55% 33% 12% Percentage >90 Uncertain What percentage of cases are attributed to MenB in Qc in children and adolescents 11% 15% 24% 20% 30%

8 CME Program An educational program was developed to address the needs of paediatricians in regards to IMD: epidemiology, immunology, national practice guidelines (NACI) vs. Quebec practice guidelines (Protocole d immunisation du Québec), and for certain remote regions on the stabilization and transfer of the patient with suspected IMD to a paediatric tertiary center Over 120 paediatricians participated in the series of six educational conferences that took place across the province of Quebec in 2011 and 2012 In the second program in 2014, there was also an update on PIQ guidelines, and on how to set-up an immunization clinic 101 paediatricians participated in the series of four conferences in spring 2014

9 Questions - Topics Carriage rate of Neisseria meningitidis in adolescents Epidemiology of IMD according to age, season Mortality of meningococcal infection Sequelae of meningococcal infection Protection against meningococal infection is conferred by Ab Need for booster dose in children with IMD before 1 y of age Booster dose of meningococcal vaccine at adolescence CPS

10 Correct Responses Pre- and Post-Tests Figure 2 Responses by Question Type All Regions Combined (Interactive Group Presentations)

11 Correct Responses Pre- and Post-Tests Figure 1: Correct Responses from Interactive Group Sessions Assessed by Pre-test and Post-test Number of responders in parentheses

12 Pre-test and Post-Test Results An increase in baseline knowledge of IMD was observed in all regions A similar increase of 31% in baseline knowledge was obtained in the online adaptation of the training program on the APQ web portal More than half (52%) stated that their practice would change as a result of attending the session Another 50% reported being interested in receiving additional information on the topics covered The majority of attendees (88%) confirmed that the program met their educational objectives 82% reported being very satisfied with the scientific content

13 Second CME Program ( ) A second CME program was developed to discuss changes in IMD epidemiology and prevention, their application to clinical practice and reassess level of knowledge of participants There was also an update on PIQ guidelines, and on how to setup an immunization clinic

14 Additional Questions - Topics There were 6 additional questions Administration of acetaminophen and immunogenicity of vaccines Maximum of 3 vaccines can be administered at the same time If a vaccine is not included in the provincially funded vaccine, it is because it is probably not efficacious The CLSC can offer a vaccine not included in the provincially funded program Quebec is the province with the highest incidence of MenB infections Most cases in Quebec in children and adolescents are caused by MenB

15 Results A total of 101 health care professionals attended the program; 66 (65%) participants completed pre and post intervention assessments of 12 questions The percentage of correct answers on the pre test was higher in 2014 vs (65% vs. 37%) Prior to the conference, 80% knew that serogroup B is the most common serogroup in Quebec but only 32% knew that IMD is more prevalent in infants <1 year of age Only 35% of responders knew the mortality rate of MenB 33% believed that administering acetaminophen with vaccines interfere negatively with the immunogenicity of the vaccines Baseline knowledge on vaccination was high Participants knowledge of IMD epidemiology and prevention increased by 6 48% based on topic and region

16 Percentage of correct answers Correct Responses Pre- and Post-Tests Percentage of correct answers for all 4 conferences 100% 90% 80% 70% 60% 50% 40% PRE POST 30% 20% 10% 0% Questions

17 Conclusions Implementation of regional CME programs resulted in significant gains in understanding of epidemiology and prevention of IMD disease in 2012 and 2014 Baseline knowledge was better in 2014, but significant gains were made with the new education program Importance of continued CME programs in immunization for physicians This is particularly important with publication of new guidelines and introduction of new vaccines

18 Questions?