Prenatal Tdap: What Works? Best Practices to Protect Moms & Babies. Rebeca Boyte, MAS, CLEC

Transcription

1 Prenatal Tdap: What Works? Best Practices to Protect Moms & Babies Rebeca Boyte, MAS, CLEC

2 What we ll cover 2» Brief Background on Pertussis» Common Problems and Possible Solutions» Resources

3 WHAT WE KNOW ABOUT PERTUSSIS 3 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 cyclical. It peaks every 3-5 years.

4 Number of reported pertussis cases by year of onset, California, * 4 Pertussis Epidemic Expected in 2018 or 2019

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 Prenatal Tdap Rates in California All Women 49% 51.9% Medi-Cal 36% 40% Private Insurance 65% 65% Hispanic 39% 44% Black 46% 43% Asian/PI 58% 63% White 62% 61% Reference: Maternal and Infant Health Assessment Survey

7 7 250,000* Pregnant women and their unborn babies left unprotected every year. *Assuming 500,000 births in California a year and roughly 50% get Tdap.

8 We all play an important role 8 Providers Public Health Pregnant Women Health Plans Pharmacists

9 9 Problem #1 NO RECOMMENDATION When providers don t recommend, mothers don t get vaccinated.

10 10 KAISER TIP: ENCOURAGE PROVIDERS TO USE PRESUMPTIVE APPROACH: You ve reached 27 weeks! Let s get that Tdap shot ready for you.

11 SF CLINIC TIP: Know your rates Get everyone onboard (Make sure all staff are documenting it the same way!) 11

12 KAISER TIP: Routinize the offer Make it easy to remember! Call EHR vendor Ask about setting up prompts starting at 27 weeks! 12

13 13 CDC TIP: Pair it with something you already do! Think Glucose Tolerance Test at 28 weeks FREE Gestational Wheel

14 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 onsite).

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16 16 If the mother was NOT immunized with Tdap at weeks of gestation, LHD can send letter to provider.

17 17 Problem #2 STOCKING CAN BE COSTLY But it doesn t have to be.

18 ACOG Tip: Join the Pediatricians! Get vaccine at a reasonable cost by joining a group purchasing org.: 18

19 CDPH TIP: Enroll in Prenatal Tdap Starter Kit! Work with your MCP:» Ask about perinatal incentives & if they can help 19

20 20 Problem #3 WEAK REFERALS Some providers need a little help.

21 Close the loop Pharmacy where woman picks up prescriptions= innetwork pharmacy Call ahead. Ensure Tdap is stocked and woman can get vaccinated there. Consider using e-rx 21

22 CDPH TIP: Adult Medi-Cal members can get immunized at in-network pharmacies. Help providers identify where they can refer: Directory of Medi-Cal Managed Care plans: 22

23 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 ) 23

24 CIC s Letter Template for Pharmacists 24 Informs provider of immunization services Helps build a bridge between prenatal care provider and pharmacy May help raise provider awareness of importance of Tdap BUT may need to be supplemented by visit or call

25 25 Problem #4 PREGNANT WOMEN ARE REFUSING TO GET Tdap But maybe they just lack information.

26 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 26 Personal beliefs I was too busy to go to the alternative site

27 27 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

28 CONTRA COSTA TIP: Start talking about it ASAP! Obtain patient consent early. 28

29 29 Promote TEXT4BABY This free service offers health tips during pregnancy and beyond. TEXT BABY to

30 CDPH Materials Also Available 30 * For download only at eziz.org * *Order FREE copies from your Immunization Program

31 31 Problem #5 It s difficult for women to go offsite. But now it s getting easier.

32 Medi-Cal MCP now offer transportation services: To learn more, see All Plan Letter: Poster coming soon! 32

33 THANK YOU! Any questions? 33 You can find me at: (510) » Resources:»

34 Still too few! What can be done to increase this? 34