Effective Community Vaccination Program Models

Transcription

1 Effective Community Vaccination Program Models Katherine Lee-Mosio, PharmD Assistant Director, University Village Pharmacy Immunization Program Coordinator University of Illinois Hospital & Health Sciences System Housekeeping If you have any questions for our speakers during the presentation, please enter them into the question box on your control panel for the webinar, located on the right hand side of your screen, and they will answer your questions at the end of the presentation. Participant phone lines are muted. A copy of this presentation will be available after the webinar at: Speaker presentation slides will be ed to participants. This webinar is being recorded. 1

2 Continuing Education Credit For those of you wanting to receive CME or CNE credits for your participation in today s webinar: You must successfully complete the evaluation that will be e- mailed to webinar participants after the webinar. Upon submission of the evaluation, participants will receive their CME certificates via within 14 days of completing the evaluation. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providershipof the American Academy of Pediatrics (AAP) and the Illinois Chapter of the American Academy of Pediatrics (ICAAP). The American Academy of Pediatrics is accredited by the ACCME to provide continuing medical education for physicians. The AAP designates this live activityfor a maximum of1.00 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity is acceptable for a maximum of 1.00 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics. The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit from organizations accredited by ACCME. Physician assistants may receive a maximum of 1.00 hours of Category 1 credit for completing this program. This program is accredited for 1.00 NAPNAP CE contact hours of which 0 contain pharmacology (Rx) content, (0 related to psychopharmacology), per the National Association of Pediatric Nurse Practitioners (NAPNAP) Continuing Education Guidelines. 2

3 Illinois Chapter, American Academy of Pediatrics (ICAAP) developed this program with funding and guidance from the Chicago and Illinois Departments of Public Health. Disclosures I have no relevant financial relationships with the manufacturer(s) of any commercial products(s) and/or provider(s) of commercial services discussed within this CME activity. I do NOT intend to discuss an unapproved or investigative use of a commercial product/device in my presentation. 3

4 Learning Objectives Identify common barriers that contribute to low adult immunizations Discuss methods to enhance access to adult vaccination services outside of the medical office Discuss the implementation of protocols and logistics involved in mass vaccination events Learn how to be a successful vaccine facilitator by hosting mass vaccine clinics The practice climate for adult immunizations is CHANGING Changes in our health-care system ACA, Medicaid expansion, Exchanges Expansion of services in nontraditional or complementary settings Stronger emphasis on the roles of all health care providers More vaccination clinics occur at workplace State immunization information systems (IISs) to include adult immunizations Federal/state funds for uninsured adult immunizations National Vaccine Advisory Committee. Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization.Practice Public Health Rep 2014;129:

5 National Adult Vaccination coverage LOWfor most routinely recommended vaccines 1 Below Healthy People 2020 targets 2 Influenza coverage 3 Early season , adults age 18 = 39% flu season = Only 41% Healthy People 2020 Target= 70% 1. CDC. Noninfluenza Vaccination Coverage Among Adults United States, MMWR2014; 63(05): Healthy People 2020 targets available at : 3. CDC. National Early Season Flu Vaccination Coverage, United States, November Barriers to Adult Immunizations Missed opportunities at provider level Vaccine availability Vaccine assessments not completed at every visit Unavailable vaccine records; suboptimal communication b/w providers Lack of provider knowledge of adult immunization schedules Preventative services are a lower priority over management of acute/chronic illnesses Institution, insurance or other policies Low rates of referral to other health professionals w/ vaccination capabilities Physical barriers: clinic hours, appt availability, lack of time, location of office Hurley LP, et al. US physicians survey regarding adult vaccine delivery: Missed Opportunities. Ann Intern Med. 2014; 160:

6 Barriers Financial Complicated reimbursement process for providers Not all providers are billable under plans Complex insurance vaccine coverage systems Medicare Part B, Part D, Medicaid, Exchanges Patient out-of-pocket costs Many unaware of ACA mandate to remove cost sharing Out of network provider Uninsured Barriers Psychological reasons Patient s unpleasant experiences Fear, difficulty of scheduling appts Patient s concerns about vaccine safety Misinformation Lack of public awareness Disease vs. preventative measures Economic & racial disparities Access 6

7 Increase access with portable community models Increase convenience Increase vaccination awareness Increase immunization rates Sustainable Immunization Programs in Community Settings Community vaccinators, outside of medical offices, are contributing to higher adult vaccination rates Mobile units and temporary clinics Pharmacy: Community, outpatient clinics and retail Workplace Schools or universities Libraries, churches, community centers, airports, polling stations CDC. Adult Immunization Programs in Nontraditional Settings: Quality Standards and Guidance for Program Evaluation. MMWR 2000;49(No.RR-1) 7

8 Benefits of adult immunization programs in nontraditional settings Expand accessibility and pt convenience Increase vaccine and preventable disease awareness Decrease financial barriers Utilizes methods that proven to increase vaccination rates in the community Our Vaccination Program Model Setting: Academic medical hospital & clinics in Chicago 7 outpatient pharmacies on campus 4 immunizing pharmacies ( ) Patient population UIC patients, UIC students and employees Other settings on campus Student centers and student gym 8

9 Our Vaccination Program Model Vaccine standing order: Seasonal influenza, pneumococcal, zoster, Td, Tdap, hepatitis A, hepatitis B, HPV, meningococcal & varicella Influenza Vaccinations Inaugural immunizing year- Fall pharmacy #92 vaccinated Current year pharmacies >#1300 vaccinated Components of Community Outreach Immunization Programs Complex and multi-layered implementation process Program Components Documents and PPs Vaccination Team Location Financial Coverage Marketing Clinic Design 9

10 Required Documents and Policies & Procedures Standing orders Source : Renew once a year, any time your protocol changes, change of medical director Policies & procedures Comprehensive PPs to cover your operations List of vaccine(s) covered under standing order Discuss the screening process for each vaccine administered Medical management process Informed Consent Forms Collect patient info, vaccine history, consent signature Document vaccine and administration info The Vaccination Team Immunizers Administer vaccine or oversee administrations by health-care students in training Completed relevant immunization training Completed BLS training every 2 years Up to date on immunizations Knowledgeable in: Policies and procedures Current adult ACIP recommendations Medical management of vaccine reactions and emergency procedures Multi-lingual IL: Pharmacists, nurses, certified medical assistants, physicians Staff: Organizer(s) or clinic manager Medical Director Greeters/educators Screeners Registration Payment collector Immunizers and assistants Security Emergency medical personnel 10

11 Location, Location, Location Pharmacies Underserved areas rural or inner city neighborhoods Academic settings On university campuses Community settings Churches, community centers, school gyms Mass transit centers Airports, train stations Financial Coverage Staff Volunteer basis Academic or job requirement Program Costs Patient costs Varies by organization, size of program Funding sources are diverse Cash price Medicare Part B (flu, pneumo & tetanus), Medicare part D Medicaid, some extended Medicaid plans Employer groups University programs, student health plans Third party insurance 11

12 Marketing Be creative Who is your target audience? Use multimedia sources Social media, local tv station, radio, mass s Print Signage, sandwich boards, posters, flyers, stickers Use your staff, it costs nothing and most effective Direct offer face to face Clinic Design Set up unidirectional patient flow Separate gathering area and post-vaccination observation area Be prepared for emergency situations Only health care worker should monitor this area Crowd management Inside and outside of clinic CDC - Guidelines for Large-Scale Influenza Vaccination Clinic Planning Health Professionals Seasonal Influenza (Flu) 12

13 Challenges Quality of services Staffing Storage of vaccines Physical location Payment/reimbursement Vaccine and administration coverage by insurance plans Managing adverse reactions offsite Illinois regulations Recordkeeping and documentation Limitations of provider s licensure to give immunizations Health-care provider liability Potential fragmentation of care Need of organized systematic procedures Helpful Principles When Conducting Adult Immunization Programs in Nontraditional Settings 7 Quality Standards per NVAC CDC. Adult Immunization Programs in Nontraditional Settings: Quality Standards and Guidelines for Program Evaluation. MMWR 2000;49(No. RR-1) 13

14 Standard 1: Information and Education for Vaccines Routinely assess and recommend at every pt encounter Offer can be done by non-vaccinating staff Prior to vaccination Screen patient using a vaccine informed consent form Provide current VIS form for each vaccination Appropriate reading level and cultural options Immunizer must be available for questions Standard 2: Vaccine Storage and Handling for Offsite Clinics Refer to manufacturer recommendations and CDC Vaccine Storage and Handling Toolkit (May 2014) Ex: Flu and pneumococcal is Fahrenheit Barrier layer between coolant pack and vaccines Calibrated temperature monitoring device (i.e. thermal glycol probe) kept close to vaccines & hourly temp. logs Keep container closed as much as possible. 1 multi-dose vial or 10 doses outside at a time Store minimum amount needed for that shift or day Do not store in trunk of car during transport Contingency plan for vaccine storage 14

15 Standard 3: Immunization History Screen patients prior to vaccination via Informed Consent form documents Previous vaccines, health conditions, allergies, adverse events to previous immunizations Standard 4: Assessment of Contraindications During screening step Refer to ACIP guidelines and manufacture s guidelines Live virus contraindications Hypersensitivities vs. Anaphylaxis Flu vaccines: Egg protein, gelatin, neomycin, streptomycin 15

16 Standard 5: Recordkeeping Informed Consent form All records of administration(s) must be retained for 5 years (IL PPA) Vaccine administrator information: Organization name, address, contact Ptinfo: Name, DOB, address, preexisting medical conditions, allergies, phone, address, PCP info: Name and contact info ( address, phone) Vaccine info: Name, dose, manufacturer, Lot #, Exp date, date next dose is due Administration info: Name of immunizer and credentials Administration date, site, IM/SC Type of VIS, VIS published date and VIS given date Pt or guardian consent w/ signature Reporting of vaccination Communicate vaccine administration to PCP IL: Within 30 days after the date of administration EMR, Fax, mailed letter No PCP per pt Document this on the consent form 16

17 Standard 6: Vaccine Administration Provider requirements Licensed Formally trained to administer vaccines Minimum BLS certified, current Know vaccine administration guidelines IM, SC, nasal routes Review prior to start of clinic AND designate a staff member(s) to monitor immunizers during clinic Know vaccine indications and contraindications Standard 7: Adverse Events Always observe post-administration Document that mins of observation was completed If pt declines, document this Have procedures in place for medical management of adverse reactions Review with staff prior to start of clinic Assign staff member(s) to monitor patients post administration Keep medical emergency kits, location of AED machine Report to PCP and to Vaccine Adverse Event Reporting System (VAERS) 17

18 Resources Immunization Action Coalition Advisory Committee on Immunization Practices (ACIP) Subscribe to Vaccinate Adults by CDC. Published quarterly Join professional organizations, local and national Questions? 18