Immunization Updates & Collaborative Projects: Working Together to Protect Moms & Babies. Rebeca Boyte, MAS, CLEC

Transcription

1 Immunization Updates & Collaborative Projects: Working Together to Protect Moms & Babies Rebeca Boyte, MAS, CLEC

2 Message from STD Branch: Think SYPHILIS! It s on the rise and it s serious. 500% increase in congenital syphilis cases in Screening is key. CA Law requires testing at 1 st prenatal visit. Also in 3 rd trimester & at delivery for women who:» did not get tested» are at high risk» live in areas with high rates Treat it ASAP. Penicillin treatment is highly effective» TX needed for pregnant women & partners» Evaluate at risk infants 2

3 OUTLINE 3» Brief Background on Pertussis» Problems and Best Practices» Other News & Resources

4 WHAT WE KNOW ABOUT PERTUSSIS 4 It s highly contagious. Babies most often catch pertussis from a family member. It s serious and can be deadly for infants. Most hospitalizations and all deaths in CA occur among infants < 4 months of age. It s preventable! All women need to get vaccinated during every pregnancy.

5 Best Protection for Infants = Tdap for Mom ACOG, AAFP, and CDC recommend: Tdap during each pregnancy Optimal timing: at the earliest opportunity between weeks. Postpartum Tdap & cocooning do not provide direct antibody protection to baby 5

6 Number of reported pertussis cases by year of onset, California, * 6 Next Pertussis Epidemic Expected SOON

7 Still too few! What can be done to increase this? 7

8 Received Tdap During Pregnancy 8 All Women 49% Medi-Cal 36% Private Insurance 65% Hispanic 39% Black 46% Asian/PI 58% White 62% MIHA 2015 Fact Sheet available: data are provisional provisional MIHA estimates are weighted to preliminary California birth certificate data and will differ slightly from MIHA estimates weighted to the final 2015 Birth Statistical Master File.

9 MIHA 2015 Fact Sheet available: data are provisional provisional MIHA estimates are weighted to preliminary California birth certificate data and will differ slightly from MIHA estimates weighted to the final 2015 Birth Statistical Master File ,000 Pregnant women and their unborn babies left unprotected every year.

10 PROBLEMS & SOLUTIONS 10 Providers Pregnant Women Pharmacists

11 11 Problem #1 NO RECOMMENDATION When providers don t recommend, mothers don t get vaccinated.

12 12 KAISER TIP: ENCOURAGE PROVIDERS TO USE PRESUMPTIVE APPROACH: You ve reached 27 weeks! Let s get that Tdap shot ready for you.

13 LA TIP: It s a group effort. Everyone needs to be onboard. 13

14 ACOG TIP: Know your rates (Make sure all staff are documenting it the same way!) 14

15 KAISER TIP: Routinize the offer Make it easy to remember! Call EHR vendor Ask about setting up prompts starting at 27 weeks! 15

16 ACOG TIP: Think Glucose Tolerance Test at 28 weeks Pair it with something you already do! 16

17 CONTRA COSTA TIP: Start talking about it ASAP! Obtain patient consent early. 17

18 Community Health Partnership TIP: Integrate Tdap education and followup into the CPSP case coordinators (C.C.) workflow* *Workflow developed by Community Health Partnership, Santa Clara, CA [2017] C.C. screens patient for understanding of needed iz during prenatal orientation C.C educates patient on need for Tdap in 3 rd trimester Patient reaches 27 weeks gestation C.C. alerts provider & MA via EHR that patient due for Tdap MA follows workflow for giving vaccines during scheduled appts.

19 Community Health Partnership TIP continued 19 C.C. completes chart review for Tdap when scheduling patient s next appt. If vaccine was not given C.C. determines reason why Tdap was not given If patient still wants Tdap C.C. will remind provider & MA of patient s appt. C.C. will notify patient that she is due for Tdap

20 GDSP TIP: Use and order CDPH s FREE gestational wheel! Order sheet: docs/pnssuppliesor derform.pdf 20

21 CDC TIP: Implement standing orders! For more info, contact Kerrie Webb at Medical Board of CA: 21

22 22 Problem #2 STOCKING CAN BE COSTLY But it doesn t have to be.

23 ACOG TIP: Join the Pediatricians! Get vaccine at a reasonable cost by joining a group purchasing org.: 23

24 CDPH TIP: Enroll to get State Tdap doses! Guidelines will be available soon! 24

25 25 Problem #3 WEAK REFERALS Some providers need a little help.

26 ACOG TIP: Providers need to close the loop. Use of e-rx being evaluated now. 26

27 CDPH TIP: Help providers identify where they can refer. Directory of Medi-Cal Managed Care plans: 27

28 This will also help pharmacists meet regulations: Report doses into IZ Registry as well as inform patient of recordsharing preferences Maintain the vaccine record at the pharmacy and provide a copy to the patient Within 14 days, notify primary care provider of immunizations administered as well as prenatal care provider (if known) California Regulations (Title 16, Section ) 28

29 CIC/Ralph s Pharmacy to Test Letter from Pharmacists 29»Letter informs provider of immunization services»helps build a bridge between prenatal care provider and pharmacy»may help raise provider awareness of importance of Tdap

30 30 Problem #4 PREGNANT WOMEN ARE REFUSING TO GET Tdap But maybe they just lack information.

31 My other children already have Tdap I was told to wait by my provider because I was sick I received a vaccine during my last pregnancy I wanted to wait until after delivery 31 Personal beliefs I was too busy to go to the alternative site

32 32 CDPH TIP: Use the prenatal immunization declination form to: stress importance of the recommendation document iz declination (required by Medi-Cal) reinforce potential consequences of choosing not to get vaccinated bit.do/izdeclinationform

33 33 Promote TEXT4BABY This free service offers health tips during pregnancy and beyond. TEXT BABY to

34 CDPH Materials Also Available 34 * For download only at eziz.org * *Order FREE copies from your Immunization Program

35 35 Problem #5 It s difficult for women to go offsite. But now it s getting easier.

36 CDPH TIP: Use this poster (IMM-1251) to promote Medi- Cal s new transportation benefit: To learn more, see All Plan Letter: Poster at: pdf 36

37 OTHER NEWS & RESOURCES

38 LHD Immunization Program Scope of Work Objective 6.1: Assist with the prevention, surveillance and control of vaccine preventable disease (VPD) within the jurisdiction. Required Activities: iv. Support investigation of infant pertussis cases. Inform LHD Maternal, Child and Adolescent Heath (MCAH) Program of each new infant case, and work together to contact the mother s prenatal care provider to determine barriers to prenatal Tdap vaccination. Follow up and assist the provider to meet the standard of care including providing strong recommendations for Tdap and a strong referral (if Tdap is not offered on-site).

39 What PSCs Can Do 39 Promote messages and best practices. Otherwise this is just a pretty PowerPoint Stay in touch with your jurisdiction s communicable disease controller: New pertussis case report form collects: Providers participation in CPSP Check for prenatal Tdap. Use LA s chart review tool

40 THANK YOU! 40 Any questions? You can find me at:» (510)