Minnesota Adult Immunization Initiatives

Transcription

1 Minnesota Adult Immunization Initiatives Annie Fedorowicz, MPH Adolescent and Adult Immunization Coordinator Women in Government Healthcare Summit November 9, 2017

2 Outline Adult Immunization Background Minnesota Immunization Information Connection (MIIC) MIIC Data Use to Support Maternal Vaccination Uninsured and Underinsured Adult Vaccine (UUAV) Program Expansion of Pharmacists Scope of Immunization Practice Taking Public Health Action to Increase Adult Immunization 2

3 Adult Immunization Background

4 Adult Immunization 101 Adult vaccination coverage is low Most coverage rates are below Health People 2020 goals Adult vaccination coverage disparities exist across: Race and ethnicity Health insurance coverage Ability to access health care (e.g. geographic location) High risk chronic health conditions And the list continues 4

5 Minnesota Immunization Information Connection (MIIC) Background

6 What is MIIC? Pharmacy Local public health Nursing home/long term care Urgent care clinic Community vaccinator Occupational health School/schoolbased clinic Convenience/ retail clinic Hospital College/ university Specialty clinic Home care/hospice Primary care clinic MIIC Child care 6

7 MIIC Data Sources: Data Connections Vital Records MIIC Refugee Health eshare Wisconsin North Dakota DHS 7

8 MIIC Policy Data privacy is a key priority MIIC data classified as private by the Minnesota Data Practices Act (Minn. Statute ) Minnesota Immunization Data Sharing Law (Minn. Statute ) Authorized users include Minnesota licensed health care providers, schools, universities, and health insurers All organizations using MIIC must sign MIIC Data Use Agreement Opt out system Policy limitations No reporting mandate No state funding 8

9 MIIC Data Use to Support Maternal Vaccination

10 Exploring Maternal Vaccination through MIIC and Vital Records Data Methods: Live births Mar Dec Matched mother s name and DOB from Vitals to MIIC 89.5% match rate in MIIC Assessed vaccination across demographics from Vitals Birth certificate data used: Gestational age at birth Prenatal care and health insurance status at delivery Race and ethnicity Maternal birth country Place of delivery 10

11 Minnesota Tdap and Flu Vaccination Coverage Among Pregnant Women, Live births March 1, 2013 December 31, 2014 Demographic Characteristics Study Population Count Tdap Vaccination Tdap Unadjusted RR 1 Influenza Vaccination Influenza Unadjusted RR 1 Overall 113, % 45.9% Health Insurance Type 2 Private Medical Assistance Military Uninsured 74,053 33,629 1,114 2, % 56.8% 60.4% 31.3% * * 48.2% 43.0% 45.3% 26.5% * * Prenatal Care Adequate Intermediate Inadequate 87,094 13,241 13, % 53.5% 43.8% * 0.72* 48.6% 43.5% 32.3% * 0.67* 1 RR = relative risk 2 Missing values for health insurance type (n = 657) & insurance type designated as other (n = 1,778) not included in table * Significant at p <

12 Using MIIC to Support Meaningful Data Driven Programming Assessed 2014 maternal flu and Tdap vaccination 15 birth hospitals with 50% flu and Tdap vaccination rates 22 hospitals with 50% flu and 50% Tdap vaccination rates 11 hospitals with 50% flu and 65% Tdap vaccination rates Using data to conduct outreach to birth facilities with low maternal vaccination rates 12

13 Uninsured and Underinsured Adult Vaccine (UUAV) Program

14 Health Insurance Coverage in Minnesota MN uninsurance rate fell from 8.2% in 2013 to 4.3% in 2015 ACA implementation begins in 2014: 200,000 more Minnesotans had health insurance in 2015 compared to 2013 Coverage changes since 2013: Increased coverage Group coverage remained steady Historical disparities persist! 14

15 Access to Affordable Vaccines through UUAV Vaccine cost is a barrier for getting adult patients vaccinated Provides free or low cost vaccine to uninsured and underinsured adults (19+ years) ~180 clinics located throughout the state in almost every county Federally funded 15

16 Expansion of Pharmacists Scope of Immunization Practice

17 Scope of Immunization Practice Expanded Minn. Statute , subd. 27(5) amended in 2015 Vaccination administration for patients: >6 years with seasonal influenza vaccine >13 years with all CDC recommended vaccines Vaccination under protocols or patient specific orders signed by a licensed prescriber (MD, APRN, or PA) 17

18 Immunization Practice Requirements Complete an ACPE accredited or BoP approved immunization course Follow immunization best practice standards Use MIIC for: Assessing a patient s immunization history prior to vaccination, except when giving influenza vaccine to patients >9 years Reporting all vaccines given 18

19 Taking Public Health Action to Increase Adult Immunization

20 Public Health Action Steps for Increasing Adult Immunization and Addressing Health Disparities 1. Know the adult vaccination coverage rates in the communities you serve 2. Vaccinate adults where they are in their communities 3. Connect adults to health care providers where they can access affordable vaccines 20

21 Acknowledgements MDH Staff: Kris Ehresmann Patricia Segal Freeman Margo Roddy Denise Dunn Jennifer Heath Miriam Muscoplat Elena Rosenberg Carlson Elizabeth Muenchow 21

22 Thank you! Annie Fedorowicz, MPH Adolescent and Adult Immunization Coordinator Vaccine Preventable Diseases Section