AIM s HPV Call to Action

Transcription

1 AIM s HPV Call to Action Sarah Strawbridge, MSM, CHES Executive Director Indiana Immunization Coalition, Inc. March 4,

2 Indiana s Approach Objectives: 1. Identify system partners to enhance HPV education and outreach 2. Describe consumer-based and provider-based education and outreach efforts to improve HPV vaccination rates 3. Recall multimedia tools to promote the importance of HPV vaccination 2

3 Background The Indiana Immunization Coalition, Inc. (IIC) is a statewide 501(c)(3), nonprofit that seeks to improve access and affordability of immunizations across the lifespan. Through immunization education, advocacy, promotion, and statewide collaborative partnerships IIC reduces the spread of vaccinepreventable diseases. 3

4 Public Health System Partners Traditional and Nontraditional Statewide and Regional Requires Collaboration and Coordination 4

5 Public Health System Partners Traditional State Dept of Health Engage more than the Immunization Division County Health Dept Public Health Nurse Meetings Public Health Association(s) APHA state affiliate SACCHO Local Survivors IAFP and INAAP State Dept of Education School of Public Health Indiana Primary Health Care Association FQHCs, CHCs Nontraditional Nonprofits Kristen Forbes EVE Foundation Indiana Rural Health Association Indiana Historical Society Town Hall Lecture Series WFYI Public Broadcasting Indianapolis IU National Center of Excellent in Women s Health Regional Coalitions Indiana Family Health Council School Nurse Association School Nurse Luncheons Little Red Door Cancer Agency Planned Parenthood YMCA/YWCA State Medical Association Pharmacists 5

6 Consumer-Based Education Public Forum A Fresh Perspective: A Dialogue with Providers Regarding HPV YWCA luncheon Webinar Series Eradicating Cervical Cancer in Indiana WFYI Sound Medicine Radio series produced by IU School of Medicine and WFYI Public Radio The HPV Vaccine, Safe for Girls and Boys Fact Sheets Vaccinate Before You Graduate Middle School and High School College Campus Initiative Dr. Oz Show Kristen Forbes EVE Foundation Movie Theater Outreach Kristen Forbes EVE Foundation and Marion County Public Health Dept 6

7 Provider-Based Education Live, Inter-Professional Educational Programs IIC quarterly membership meetings Association meetings Breakout sessions on HPV during IAFP meetings Presentations at statewide conferences Webinar Series (live and enduring material) Eradicating Cervical Cancer in Indiana for password State Dept of Health Reminder Recall Initiative 7

8 Multimedia Tools Social Media and Print Media Facebook Twitter Press Releases Radio Radio PSAs Interviews Live and Pre-Recorded Radio Interviews WORDonCancer Public Service Announcements (PSAs) HPV specific PSAs (varying in length) 8

9 Moving Forward Reframe the Discussion Encourage providers to take advantage of every teachable moment Improving Access and Affordability Legislation Little Red Door and Planned Parenthood Initiative Kristen Forbes EVE Foundation Women in Government School Requirements List as Recommendation School Nurse Reference Packet Include Talking Points 9

10 Thank you! Sarah Strawbridge, MSM, CHES Executive Director Indiana Immunization Coalition, Inc "Like Vaccinate Indiana on Facebook Follow us on 10

11 NC Immunization Branch & Cervical Cancer-Free NC HPV Efforts Amanda Dayton, NCIR Unit Manager Schatzi H. McCarthy, Assoc. Director CCFNC March 4,

12 Purpose of Today s Meeting Learn about HPV vaccination services, challenges and opportunities in NC school-based health centers Learn best practices for school-located vaccine programs to improve adolescent immunization rates Understand the benefits and challenges of developing an adolescent AFIX program--a quality improvement strategy to increase adolescent immunization coverage among vaccine providers 2

13 What is CCFNC? 3

14 CCFNC Started in 2010 Successes: Screening reminders to 10,000 adult women Vaccination information to over 5,000 parents Vaccination intervention, reaching over 130,000 teens Bi-lingual cervical cancer resource directory identifying over 150 county-specific free and low-cost screening resources Partners: NC Division of Public Health Immunization Branch, BCCCP, Local Health Departments School Health Centers Professional Associations 4

15 School-based Research Initiatives 5

16 National Programs offering HPV Vaccine Objective: to identify all vaccination programs that offered the HPV vaccine in schools without SHCs to describe program characteristics and identify best practices. Lessons learned: Promote adolescent platform, not just HPV Median rates of HPV vaccine uptake: Initiation 10% Completion 78% Programs were grant-funded; no way to bill private insurance Building collaborative and sustainable partnerships with schools is essential Paper: Guidance on offering the HPV vaccine in US schools without school health centers 6

17 NC Mass Vaccination Programs Aims 1) Identify best practices for the delivery of vaccinations in school-based settings 2) Use identified best practices to plan for broader vaccine coverage in school settings. Activities Interviewed 3 NC providers NCSCHA members Paper: Successes and challenges of school-located vaccination efforts in three North Carolina counties 7

18 Survey of SHCs in NC Objectives: To determine which SHCs stock the HPV vaccine; and To assess barriers to HPV vaccine provision in North Carolina SHCs to inform subsequent interventions. Lessons learned: 33 out of the 53 NC SHCs offered the HPV vaccine (62%) Key Barriers: Out-of-pocket costs to receive privately purchased HPV vaccine Students not returning the consent form Upfront costs of ordering/stocking privately purchased HPV vaccine. Most SHCs (82%) were interested in interventions to increase HPV vaccine uptake, but had limited staff to support efforts. Paper: Opportunities to increase HPV vaccine provision in NC school health centers 8

19 SHC Intervention Project Partners Rockingham SHCs and 4 Comparison Sites NC School Community Health Alliance, Connie Parker Aims Increase provision of adolescent vaccines HPV, Tdap, meningococcal and flu Evaluate a sustainable intervention If it works, disseminate to organizations working in NC schools 9

20 SHC Intervention Project Intervention packets Mailed to ~5000 parents of adolescents Flyers and letter Vaccination consent form Evaluation Vaccination, from medical records Interviews with parents about materials 10

21 Materials: Promotional Flyer 11

22 Materials: Consent Form 12

23 SHC Intervention Project Most parents did not return the forms (84%). Of parents consenting to adolescent vaccines for their child, 79% (246/311) used the check all box. Table 1: Vaccination Form Completion Delivered Packets Form Unreturned Form Returned w/o signature or consent Form Returned with consent for all vaccines Form returned with consent for specific vaccines (84%) 169 (6%) 246 (8%) 65 (2%) 13

24 Consent Form Dissemination Project Evaluate the effectiveness of parent consent form Provision of adolescent vaccines (HPV, Tdap, meningococcal conjugate and influenza) Compare Improved consent form with check all box Improved consent form without check all box Regular consent form Randomized children (not schools) to consent form condition Results are pending 14

25 School-located Practice Initiative 15

26 Mass Vaccination Mgmt Academy Develop a School Vaccination Training Academy Help five county health departments develop a business plan Follow them as they implement mass vaccination in schools in their counties 16

27 Mass Vaccination Mgmt Academy Progress to Date: Developed a business plan template for program planning Conducted two webinar trainings re: feasibility planning and business plan development Constraints: Commitment to free training by program participants 17

28 Overall summary NC has some valuable schoolbased vaccination programs in place, that are serving as a model for others. Efforts should target the adolescent platform rather than specific vaccines. Sustainability of these efforts needs to be strengthened through the billing of private insurance. Additional strategies are needed to encourage higher consent form return rates and increased uptake. 18

29 Adolescent AFIX Evaluation 19

30 Purpose & Design Primary Purpose: Assess the effectiveness of adolescent AFIX Secondary Purpose: Comparison of In- Person AFIX and Webinar AFIX Groups: In Person 30 providers received inperson AFIX visit Webinar 31 providers received webinar AFIX visit Control 30 providers received no intervention Measures: Change in coverage rates Baseline versus 5 month follow-up Cost Effectiveness In-Person versus Webinar 20

31 Typical Adolescent AFIX Visit Each practice received: 2 Coverage Reports per practice State, National & County level rates An analysis of missed opportunities A list of patients who are missing immunizations Training on how to use the reminder/recall function of the NCIR (if necessary) Strategies on how to improve adolescent rates 21

32 Assessment Overall Rate 2MMR, 1Meng, 1Tdap, 3Hep B Individual Rates for: 2MMR 1Tdap 1 Meng 3 Hep B 1 and 2 Var 1, 2, and 3 HPV(girls only) 22

33 Sample Coverage Rate Report 23

34 24

35 Sample County Rankings Summary 25

36 Results 26

37 HepB3, Meng1, MMR2, Tdap1 Vaccination Rate Change: y.o. Baseline to 5 Months Control In Person Webinar Intervention 10% Change in Percent 8% 5% 3% 8.7% 8.2% 7.5% 3.8% 0% Baseline 5 Months 27

38 Tdap1 Vaccination Rate Change: y.o. Baseline to 5 Months Control In Person Webinar Intervention 10% 8% Change in Percent 5% 3% 5.0% 4.7% 4.5% 2.8% 0% Baseline 5 Months 28

39 Meng1 Vaccination Rates: y.o. Baseline and 5 Months Control In Person Webinar Intervention 10% Change in Percent 8% 5% 7.3% 7.0% 6.7% 3.8% 3% 0% Baseline 5 Months 29

40 HPV1 Vaccination Rate Change: y.o. Baseline to 5 Months Control In Person Webinar Intervention 10% 8% Change in Percent 5% 3% 3.8% 3.3% 3.5% 2.3% 0% Baseline 5 Months 30

41 HPV3 Vaccination Rate Change: y.o. Baseline to 5 Months Control In Person Webinar Intervention 10% 8% Change in Percent 5% 3% 3.6% 2.9% 2.4% 2.0% 0% Baseline 5 Months 31

42 Cost Effectiveness Average Cost per Visit In Person Webinar Staffing Visit preparation (2 hours) Visit (1 hour in-person, 1.5 hours webinar) Travel to visit (2 hours) Travel Mileage (125 $0.30/mile) Lodging and meals * $41.02 $20.51 $41.02 $37.50 $12.40 $41.02 $30.77 n/a n/a n/a Mailings n/a $15.58 Webinar license ($390/year) n/a $12.58 Total $ $99.95 * Over the course of the 30-visit intervention, the in-person condition required 3 overnight trips for a total cost of $

43 Provider Feedback 33

44 Ratings: Importance of AFIX Visit Components Component In Person Webinar Missing Immunization Report Adolescent Assessment Report County Rankings Summary NCIR Reminder/Recall Training State/National Adolescent Rate Summary = very unimportant 3 = neutral 5 = very important 34

45 Confidence in Running NCIR Reminder/Recall Query Confidence Level In Person Webinar Before After Before After Very confident 17% 60% 10% 35% Somewhat confident 33% 33% 13% 62% Neither 7% 3% 29% 0% Somewhat unconfident 13% 0% 13% 0% Very unconfident 30% 3% 35% 3% 35

46 Five Month Follow-Up: Reported Increases in Effort Activity In-Person Webinar Enter historical immunizations 67% 100% Target adolescents who could be up-to-date with one more visit Inactivate adolescents in NCIR who are not seen by practice 63% 58% 57% 55% Utilize a reminder/recall system 57% 45% 36

47 Summary Both in-person and webinar AFIX visits helped improve immunization rates Overall feedback very positive from both in-person and webinar groups Webinar visits were 50% more cost effective than inperson visits Both in-person and webinar intervention sustainable and easy to replicate 37

48 Any Questions? 38