ACIP Recommendations for Adult Pneumococcal Immunization: Helping Pharmacists Assess, Recommend, Administer or Refer. Interim Outcomes Report

Transcription

1 ACIP Recommendations for Adult Pneumococcal Immunization: Helping Pharmacists Assess, Recommend, Administer or Refer Grant ID: Interim Outcomes Report

2 Program Information Overview: This enduring series of online activities effectively combines an exciting TED-style talk with two accredited clinical commentary webcasts, to provide learners with meaningful education that discusses pharmacist-specific strategies for improving adult pneumococcal immunization. Featuring Dr. Michael Hogue, Dr. Andrea Pallotta, and Dr. Michelle Rager, this series reviews the most recent information related to targeted vaccination rates, how to identify at-risk adults, ACIP vaccination recommendations, and future directions, while also highlighting real opportunities for improved communications with patients. Intended Audience: This educational activity was designed for pharmacist in multiple settings who may assess, discuss, refer, and administer vaccinations to adults. Release/Expiration Date: January 31, 2017/January 31, 2018 Credit: 0.75 contact hours (.075 CEUs) ACPE credit Sponsored By: The Academy for Continued Healthcare Learning (ACHL) Funding: Supported by an educational grant from Pfizer

3 Faculty Michael Hogue, PharmD, FAPhA, FNAP Associate Dean and Professor Center for Faith and Health Samford University College of Health Sciences Birmingham, AL Andrea Pallotta, PharmD, BCPS Infectious Diseases/HIV Clinical Specialist Cleveland Clinic, OH Michelle Rager, BA, PharmD Associate Professor and Interim Department Chair of Pharmacy Practice Shenandoah University Bernard J. Dunn School of Pharmacy Winchester, VA

4 Executive Summary Reach 3169 Learners (2,000 Guaranteed by activity expiration) 2118 Certificates (350 Guaranteed guarantee exceeded) Satisfaction All faculty were very highly rated with an average rating of 3.66/4.0 98% of learners rated all aspects of the activity as excellent or good Learning Objectives 99.6% of participants strongly agree/agree that they are better able to meet the learning objectives after completing the activity Impact 2/3 of learners will change their practice based on this activity; 76% plan to incorporate changes immediately 58% intend to change how they counsel patients 52% of learners will seek to address potential barriers to patient access to therapies Icon made by FreePik from

5 Executive Summary (cont) The following summarizes key improvements demonstrated from the initiative. Knowledge/Competence: Average of 81% increase overall from pre to post Shortcomings in, and the need to improve, current adult pneumococcal vaccination rates Proficiency in appropriate pneumococcal vaccine timing and schedules Pharmacist-driven strategies for improved patient engagement and counseling Opportunities for pharmacists to actively improve pneumococcal vaccination rates Accredited Activity Impact (Intended Changes): Improved mean confidence (2.66 pre vs 3.60 post) related to ability to effective counsel patients on pneumococcal vaccines Improved intention to discuss pneumococcal vaccines with eligible adult patients from baseline (2.55 pre vs 3.28 post) Non-Accredited Activity Impact (Intended Changes): 47% of learners found the TED-style webcast useful 81% of follow-up survey responders indicated that they implemented a practice change as a result of watching this resource Evaluation of learner improvements across all core concepts from this initiative underscore its success and provide a platform for continued enhancement of pneumococcal vaccination. Additionally, the unique TED-style resource served to empower pharmacists to more proactively engage and counsel patients on their immunization history, which may translate to continued proficiency and practice improvements!

6 Executive Summary Future Educational Opportunities Provide more real-world strategies for pharmacists and their staff to address potential barriers and improve ability to proactively engage patients regarding their immunization history Provide up-to-date education for pharmacists on vaccination guidelines, as well as tools to educate colleagues regarding these updates Offer educational opportunities that allow pharmacists to practice strategies for appropriately addressing shortcomings in pneumococcal vaccination rates Icon made by FreePik from

7 Level 1: Participation 7% 1%0% 1% Profession Total Participants Certificates Awarded Pharmacist Pharmacy Tech Physician Nurse Other 91% N=2095

8 Level 1: Practice Setting Community/Retail 60% Health System/Hospital 22% Long-term Care 4% Specialty Care 2% Managed Care 2% Other 9% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% N=2095

9 Level 2: Learning Objectives Please rate the following objectives to indicate if you are better able to: Discuss patient- and system-related barriers to achieving national standards for adult vaccinations Outline recommendations and schedules for pneumococcal vaccination in older and highrisk adults Formulate strategies to address patient questions and concerns about vaccination requirements Describe opportunities to expand the role of pharmacists in the administration of adult vaccines Analysis of Respondents Rating Scale: 4 = Strongly Agree 1 = Strongly Disagree % of learners strongly agree or agree that all learning objectives were met. N=2110

10 Level 2: Satisfaction Faculty Ratings: Accredited Clinical Commentaries Rating Scale: 4=Excellent, 1=Poor Ability to effectively convey the subject matter Ability to deliver an objective/ balanced presentation Ability to present scientifically rigorous information Expertise on the subject matter Andrea Pallotta, PharmD, BCPS Michelle Rager, BA, PharmD All faculty were highly rated across all areas, with an average rating of 3.66/4. Overall Evaluation Analysis of Respondents 4 = Excellent, 1 = Poor Objectivity and balance 3.64 Quality of educational content 3.64 Usefulness of educational material 3.64 Effectiveness of teaching methods 3.63 Effectiveness of active learning strategies 3.63 N= % of learners rated all aspects of the activity as excellent or good!

11 Levels 3 & 4: Pre/Post-test Overview Overview of correct responses: 100% 75% 50% 25% 0% 35% 87% 95% 94% 93% 58% 65% 56% Topic Question Pre Post % Change Understanding patient- and system-related barriers to optimal adult vaccination Recommendations/schedules for pneumococcal vaccine in older adults 1 35% 87% 149% 2 58% 95% 64% Strategies for patient counseling 3 65% 94% 45% Expanding the role of the pharmacist 4 56% 93% 66% 81% Average percent change from pre to post-test Learners knowledge and competence increased across all key clinical concepts, including recognition of vaccination recommendations for adults, pharmacist-led strategies for improving immunization in these patients, and particularly regarding shortcomings in current adult vaccination rates.

12 Levels 3 & 4: Pre-test vs. Post-test According to 2014 data from the Centers for Disease Control and Prevention (CDC), approximately what percentage of adults aged 65 years and older has received a pneumococcal vaccination? A. 35% B. 60% C. 75% D. 90% 100% 75% 56% Pre (N=3170) 87% Post (N=2116) 50% 35% 25% 0% 12% 7% 1% 2% 0% A B C D The number of participants correctly answering the post-test question increased by 149% over the pre-test, demonstrating that participants were more knowledgeable regarding the shortcomings in pneumococcal vaccination rate in older adults which is especially important to motivate clinicians to more actively engage appropriate patients to consider getting vaccinated.

13 Levels 3 & 4: Pre-test vs. Post-test GM receives counseling from his pharmacist on his need for a pneumococcal vaccine several weeks after turning 65 years of age. He has not been vaccinated, is healthy, and is interested receiving the vaccine at the pharmacy that day. What vaccine schedule should be followed for GM? A. A dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) during today s visit followed by a dose of pneumococcal conjugate vaccine (PCV13) one year later B. A dose of PCV13 during today s visit followed by a dose of PPSV23 one year later C. A dose of both PPSV23 and PCV13 during today s visit D. A dose of PPSV23 during today s visit followed by a dose of PCV13 within 6 months 100% 75% 50% 25% 0% 23% 3% Pre (N=3170) 95% 59% Post (N=2116) 6% 12% 1% 1% A B C D Learners were 64% more likely to correctly answer the post-test question as compared to pre-test, indicating an increased knowledge and proficiency of appropriate pneumococcal vaccination schedules for older adults. These improvements may provide a solid baseline for improved pharmacist-driven utilization of pneumococcal vaccines.

14 Levels 3 & 4: Pre-test vs. Post-test Which of the following best describes the rationale behind ACIP s recommendation for the order in which the PCV13 and PPSV23 vaccines are administered? A. The tolerability and incidence of adverse events is improved with this sequence Pre (N=3170) B. This vaccination sequence follows that for infants and children, reducing confusion C. The immune response to this 100% 75% sequence is greater D. It was important to have the vaccination schedule follow 50% Medicare coverage for older adults 25% 18% 10% 3% 1% 0% Post (N=2116) 65% 94% 7% A B C D 2% Learners demonstrated a 45% increase in selecting the correct answer from pre- to post-test, indicating an improved knowledge of appropriate sequencing of vaccines that promotes an improved immune response. This increased knowledge can lead to more effective patient counseling and improved immunization.

15 Levels 3 & 4: Pre-test vs. Post-test JP, a 66-year old woman who is new to your pharmacy, requests an influenza vaccine. Upon questioning about whether she has ever received a pneumococcal vaccine, she does not recall, and has not been seen by her doctor within the past year. She asks whether she can receive a pneumococcal vaccine during today s visit. How would you counsel JP? A. She is eligible for a pneumococcal vaccine, but should wait until 6 months after receiving the influenza vaccine B. She should follow up with her primary care provider to discuss her needs C. She should confirm whether she was previously vaccinated against pneumococcal disease as there are potential safety concerns with extra doses D. She can receive the inactivated influenza vaccine and her first dose of the pneumococcal vaccine during this visit 100% 75% 50% 25% 0% Pre (N=3170) Post (N=2116) 93% 56% 21% 14% 9% 1% 2% 4% A B C D The number of participants correctly answering the post-test question increased by 66% over the pretest, demonstrating increased learner knowledge and competence regarding making patient-specific recommendations for pneumococcal vaccine. Pharmacists are in a unique position to effectively counsel patients on appropriate immunization opportunities and immunize patients.

16 Level 4: Confidence How confident are you in your ability to effectively counsel patients regarding their potential concerns associated with pneumococcal vaccines? (4 = very confident, 1 = not confident at all) A. 4 Very confident B. 3 Moderately confident C. 2 Somewhat confident D. 1 Not at all confident 75% 50% 66% 41% Mean Pre: 2.66 Mean Post: % 0% 30% 31% 18% 4% 10% 0% A B C D Mean confidence improved from pre- (2.66) to post-test (3.60), demonstrating improvement in subjective confidence related to ability to effectively counsel patients on pneumococcal vaccines. Pre N=3170; Post N=2095

17 Level 4: Intended Practice How often do you plan/now intend to plan to discuss pneumococcal vaccines with your eligible adult patients? (4 = always, 1 = never) A. 4 Always B. 3 Often C. 2 Rarely D. 1 Never 75% 50% 41% 43% 49% Mean Pre: 2.55 Mean Post: % 25% 0% 11% 7% 10% 3% A B C D Mean response at post (3.28) increased from baseline mean (2.55), demonstrating an increased intention to discuss pneumococcal vaccines with eligible adult patients. Pre N=3170; Post N=2095

18 Level 4: Activity Impact Please identify how you will change your practice as a result of participating in this activity (select all that apply). Change how I counsel patients on vaccines 58% Create/revise protocols, policies, and/or procedures 18% This activity validated my current practice; no changes will be made 32% Other 2% N=2110 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% Two-thirds of learners indicated that they will make a change to their practice as a result of participating in this activity, especially regarding how they counsel their patients about vaccines.

19 Level 4: Activity Impact How soon do you intend to incorporate changes into your clinical practice as a result of this CE activity? Immediately 76% In one month 7% In three months 3% In six months 3% N/A (not practicing) 11% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% N=2095 The vast majority (76%) of learners indicated that they intend to incorporate practice changes immediately.

20 Level 4: Barriers Please indicate any potential barriers you perceive in implementing practice changes. Familiarity with ACIP/CDC guidelines Lack of administrative support Cost Lack of experience Lack of time to assess/counsel patients No barriers Lack of opportunity (patients) Reimbursement/insurance uncertainty Lack of stocked vaccine Vaccination status unclear Other 9% 5% 5% 3% 7% 3% 1% 3% 4% 27% 33% N=2095 0% 5% 10% 15% 20% 25% 30% 35% 40% The greatest barrier to implementing practice changes indicated by learners is lack of time to assess/counsel patients (27%).

21 Level 4: Barriers N=2095 Will you attempt to address these barriers in order to implement changes in your performance, and/or patients outcomes? Yes: 52% No: 8% N/A No barriers identified: 40% Yes, how? Educate patients on immunization, however most of my patients are self-pay and vaccines are expensive Improved counseling of patients, stressing the importance of immediate vaccine administration Spend more time with patients Take advantage of overall coverage to devote time to administer/counsel in a timely manner Start with one patient and increase as time permits Indicate on prescription bags Train technicians to identify patient eligibility Utilize technicians more to free up pharmacists time In process of policy revision Request we carry more vaccines Waiting on response from supervisor to improve workflow Hang up current CDC recommendations in pharmacy Train staff and better manage time No, why not? Cost issues for patients who self-pay Time constraints barriers are not possible to address in my busy practice setting Until pharmacies are better staffed, it is not possible to find more time 52% of learners are interested in addressing barriers, primarily through patient education, improved technician training to increase availability of time for pharmacists to engage with patients.

22 Level 5: Non-Accredited Resource Post Did you find the nonaccredited video with Dr. Hogue useful? (N=2095) Yes: 47% No: 5% I haven t watched the video: 48% Which of the following strategies DO YOU PLAN to do after viewing this TED-style talk? (N=2094) Sign up for ACIP alerts on pneumococcal vaccinations 16% Sign up for my state vaccine registry 10% Address system-related barriers in my clinical setting Provide patients with a strong recommendation for vaccination Increase assessment of vaccine status in older adults 11% 27% 36% 0% 20% 40% 47% of learners watched the TED-style talk with Dr. Hogue and indicated that they found it useful. Additionally, participants indicated that they planned on implementing strategies in practice as a result of watching this nonaccredited resource, particularly strongly recommending vaccination for appropriate patients (36%), increasing the assessment of vaccine status in older adults (27%), and signing up for ACIP alerts on pneumococcal vaccines (16%).

23 Level 5: Non-Accredited Resource 60-day Follow-up Did you find the nonaccredited video with Dr. Hogue useful? (N=144) Yes: 66% No: 6% I haven t watched the video: 28% Which of the following strategies DID you do after viewing this TED-style talk? (Select all that apply) (N=117) Sign up for ACIP alerts on pneumococcal vaccinations Sign up for my state vaccine registry Address system-related barriers in my clinical setting Provide patients with a strong recommendation for vaccination Increase assessment of vaccine status in older adults 9% 14% 17% 52% 58% 0% 20% 40% 60% 80% 66% of the activity participants who responded to the follow-up survey indicated that they found the TED-style resource useful, with the majority of survey participants (81%) indicating that they implemented a clinical strategy as a result. Most frequently noted implemented strategies include, providing patients with a strong recommendation for vaccination (58%) and increased assessment of vaccine status in older adults (52%)

24 Topics of Interest What topic areas would you most like to see in future activities? (Check all that apply) Patient education strategies ACIP recommendations 38% 41% System-related changes 8% Other vaccinations 44% Other 3% 0% 20% 40% 60% Clinicians indicate interest in all four topics provided, however this outcomes report demonstrates learners are most in need of education on other vaccinations, ACIP recommendations, and strategies for improving patient education. N=2110

25 Key Takeaways What is one pearl you took away as a result of your participation? When in doubt, immunize now Better clarified the guidelines Refreshed my knowledge The types, scheduling and necessity of pneumococcal vaccination in adult patients over age 65 Sequence of PNA vaccine and reason why Counseling techniques Discuss immunizations with every patient Importance of vaccines Evaluate every patient How deadly pneumonia can be in adults 65 and older Ok if patient receives a dose due to uncertainty The age necessary Do not be afraid to counsel and recommend vaccines to our patients and be confident and firm when talking and recommending vaccines Timing Keep on immunizing Get to know your patients and keep up with the Updates from CDC Always give 13 before 23 More knowledge about pneumonia and pneumococcal vaccination Indications for pneumococcal vaccines and the order of administration for the two products Value of pharmacist-patient interaction Clarification on immunization Dosing intervals if patient has received PPSV23 before age 65 Must speak positively to patients about getting vaccines in a counseling area and the importance about being in contact with young children not yet immunized Pharmacists can have a huge impact on immunizations Better interaction with patients The great need for vaccination of all people over 65 who are not vaccinated The need to increase awareness of vaccine importance The difference between two adult doses Only 60% vaccinated Understand and address concerns patients have Recommended dosage of administration Age and correct vaccine Make time and make priority Updated my knowledge on the difference and the sequence of both vaccines Importance of pushing for vaccination The vaccination can be given again if patient is unsure if they had it before Get the patient vaccinated at age 65 May give both vaccinations the same day Immunization saves lives Stronger evidence of importance of vaccination The Pneumococcal conjugate vaccine provides a better initial immune response Always take opportunity to discuss vaccines with patients Not to be afraid to recommend vaccinations

26 Key Takeaways What is one pearl you took away as a result of your participation? The sequence of administering PCV13 and PPSV23 in adults over age 65 The importance of having one year between the two forms of the vaccine Herd immunity and protecting others in family Pharmacists must step up and inform and educate patients about the importance of preventable disease The importance of discussing vaccines with all patients Tips to deal with waffling patients The importance of vaccinations for patients >/= 65 years of age, especially those at higher risk due to other disease states I didn't know about the 2020 goal to get 90% vaccination rate for those over 65. I also didn't know the disease can be spread from children to adults and vice versa Need for education to why vaccines are needed. How to approach patients on vaccinations Being with grandkids can get you sick...great line to get those patients vaccinated as they love being with the little ones Check into state vaccine registry for patient information Redirect patient away from current payment activity to more professional health counseling activity Encourage eligible patients to be immunized immediately (on the day of the discussion) rather than return visit avoid missing opportunity That persons who are 65 years and over, or have Diabetes, COPD or are Immuno-Compromised conditions should be vaccinated Dr Hogue's video of how to approach a patient that is immunocompromised and over 19 How to counsel patients that react negatively to immunizations How important the role of the pharmacist is and their accessibility to the patient in advocating vaccines Change the way we address the question Address concern about vaccine causing sickness Discuss vaccines with patients in private, take them aside The value of assessing patients' needs and how to counsel It is reasonable to administer the pneumococcal vaccine to patients who do not have documentation of vaccination; extra doses will not cause harm The schedule for younger at risk patients Must take time to assure patients of the safety and benefits of vaccinations The role of the pharmacist to improve the health of the elderly population in the community The pharmacist is in a unique position to educate patients about the importance of receiving appropriate vaccines and to provide education regarding any misconceptions or concerns the patient may have that could potentially prevent vaccination ACIP recommendations and reasons behind the recommended schedule The availability of ACIP Alerts That pneumonia requires 400,000 hospitalizations per year Use of EMR in alerting pharmacists to administer vaccine even when not dispensing provides an opportunity to improve vaccination rates

27 Next Steps Final outcomes report to be provided 60 days post-activity expiration (March 2018) For questions, please contact: Richard Keenan VP, Education Development Academy for Continued Healthcare Learning (ACHL) E: P: ext. 215 C: