Advancing HPV Vaccination in Your Practice Jane Pezua, MPH Health Educator Adolescent Immunization Coordinator

Transcription

1 Advancing HPV Vaccination in Your Practice Jane Pezua, MPH Health Educator Adolescent Immunization Coordinator California Department of Public Health 1

2 Objectives Understand burden of HPV disease Describe ACIP HPV vaccine recommendations Understand what makes a strong recommendation for HPV vaccine Name 3 strategies to increase HPV vaccination in your clinic List 3 resources available to support parent and provider education about HPV vaccine California Department of Public Health 2

3 WHY DO WE CARE ABOUT HPV? California Department of Public Health 3

4 Steve s Story California Department of Public Health 4

5 ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES: HPV VACCINE RECOMMENDATIONS California Department of Public Health 5

6 ACIP HPV Vaccine Recommendations Routine HPV vaccination at years As early as 9 years (Recommended for children with history of sexual abuse or assault.) Females years and males years if not adequately vaccinated previously Males years may be vaccinated Men who have sex with men*, transgender persons, or immunocompromised persons (including those with HIV) years if not adequately vaccinated *Including men who identify as gay or bisexual, or who intend to have sex with men. California Department of Public Health 6

7 HPV Vaccine Timing Chart California Department of Public Health 7

8 HPV AND HPV VACCINE IN CALIFORNIA California Department of Public Health 8

9 Disease Burden: Number of New HPV-Associated Cancer in CA, 2015 Oropharynx % % Anus Penis Vagina Vulva 98 2% 301 7% 126 3% % Cervix N=4,340 California Department of Public Health 9 Source: California Cancer Registry, California Department of Public Health

10 Estimated Vaccination Coverage Among Adolescents Aged Years, CA, NIS-Teen, % 73% 80% 49% California Department of Public Health 10

11 Estimated impact of 49% UTD rate in CA with HPV vaccine 1.5 million year olds* 735,000 UTD 765,000 not UTD 5,145 cancers AVERTED 5,355 cancers we failed to avert Assumption: for every 1,000 pre-teens vaccinated, we can prevent ~7 HPV-associated cancers over their lifetimes (from personal communication with Dr. Melinda Wharton, CDC) *Source: Dept of Finance Data 2017 California Department of Public Health 11

12 STATE EFFORT TO IMPROVE RATES AMONG VFC PROVIDERS California Department of Public Health 12

13 HPV Ratio Letter ~500 Vaccines for Children clinics Ratio of doses administered of HPV:Tdap 1:1 Resources: Tips and Tools flyer Be an HPV Vaccination Champion webinar VFC field representatives View template at: California Department of Public Health 13

14 Results of Ratio Letter (Feb Aug 2017) 65% (298) 61% (182) Achieved 1:1 ratio 552 Received letter 461 Ordered vaccine Improved 35% (163) 18% (53) Achieved 2:1 ratio Did not improve 91 Excluded* *ratio could not be calculated because they ordered insufficient doses of HPV and/or Tdap vaccines or were inactivated California Department of Public Health 14

15 HOW YOUR CLINIC CAN MAKE A DIFFERENCE: MAKING A STRONG RECOMMENDATION California Department of Public Health 15

16 Why is HPV Vaccine Coverage so Low? Parents No provider recommendation Perceive vaccine as optional Perceive that provider discouraged vaccination (or timely vaccination) Lack of information Safety Rationale for vaccination at young age Providers Reluctant to give multiple shots Do not make strong recommendation Recommend based on their estimation of sexual activity Underestimate risk of HPV infection Perceive HPV as emotionally charged Delay vaccination Source: Perkins RB et al. Pediatrics 2014;134:e666-e674 California Department of Public Health 16

17 [W]hen I think about it unconsciously, when I see this skinny little kid here, with parents, and they talk and they re barely doing anything, and I d be shocked if they became sexually active at a really young age. -Pediatrician California Department of Public Health 17

18 I don t get as scared of cervical cancer because the Pap test is another screening method. So the other things just feel more dramatic to me and it s not like HPV is going to kill the boys. -Pediatrician California Department of Public Health 18

19 Introducing vaccines Accepted vaccine Announcement It s time for shots. 90% Optional What do you want to do about shots? 17% Source: AJPH (Opel et al., 2015) California Department of Public Health 19

20 Announcement Approach Announce Note child s age Announce children this age are due for vaccines that prevent several diseases, placing HPV vaccine in middle of list Say you will vaccinate today If parent hesitates Connect Ask parent for their main concern. Find common ground Clarify Use an evidence-based message to addresses their concern Counsel Make a clear recommendation to get HPV vaccine today You could say I see here that Michael just turned 11. Because he s 11, Michael is due for vaccines against meningitis, HPV cancers, and whooping cough. We ll give those at the end of today s visit. You could say So, what is your main concern? I hear what you re saying. Here s the thing. Kids respond more strongly to HPV vaccine when they are younger. I recommend your child get the HPV vaccine today. Presentation by Dr. Noel Brewer, CDC California Department of Public Health 20

21 Announce I see here that Abby just turned 11. Because she s 11, Abby is due for meningitis, HPV, and Tdap vaccines. We ll give those at the end of today s visit. Now that Luis is 12, there are three vaccines we give to kids his age. Today, he ll get meningitis, HPV, and Tdap vaccines. Source: Presentation by Dr. Noel Brewer, CDC California Department of Public Health 21

22 Announcement Approach Announce Note child s age Announce children this age are due for vaccines that prevent several diseases, placing HPV vaccine in middle of list Say you will vaccinate today If parent hesitates Connect Ask parent for their main concern. Find common ground Clarify Use an evidence-based message to addresses their concern Counsel Make a clear recommendation to get HPV vaccine today Source: Presentation by Dr. Noel Brewer, CDC You could say I see here that Michael just turned 11. Because he s 11, Michael is due for vaccines against meningitis, HPV cancers, and whooping cough. We ll give those at the end of today s visit. You could say So, what is your main concern? I hear what you re saying. Here s the thing. Kids respond more strongly to HPV vaccine when they are younger. I recommend your child get the HPV vaccine today. California Department of Public Health 22

23 Messages for Clarifying Step Age Sex Safety Effective Guidelines Boys Requirements Source: HPVIQ.org Kids respond more strongly to HPV vaccine when they are younger. This may give better protection against some cancers. This really isn t about sex. The HPV vaccine is about preventing cancer. This vaccine is one of the most studied medications on the market. The HPV vaccine is safe, just like the other vaccines given at this age. Over 30,000 Americans get cancer from HPV every year. Most could be prevented with the HPV vaccine. Experts at the CDC agree that kids should get the HPV vaccine by age 11 or 12 to prevent several cancers. HPV infections don t care if you re a boy or girl. The virus can cause cancer and many other diseases. School requirements don t always keep up with medical science. The HPV vaccine is an important vaccine that can prevent many cancers. California Department of Public Health 23

24 Tips from your Peers Focus on cancer prevention, not sex If sex or STIs come up, refocus on cancer prevention Treat HPV vaccine the same as required vaccines If the vaccine being not required comes up, refocus on recommendations being equally strong for all 3 vaccines Advise parents not to delay protection Presentation by Dr. Noel Brewer, CDC California Department of Public Health 24 24

25 Keep ALL Staff on the Same Page Align communication with mission Give staff a cancer prevention mission All staff need to be saying the same thing Share talking points Use the Tip Sheet Educate staff about HPV vaccine recommendations (schedule, administration, storage and handling) California Department of Public Health 25

26 HOW YOUR CLINIC CAN MAKE A DIFFERENCE: SYSTEMS STRATEGIES California Department of Public Health 26

27 Anyone who has ever asked for 2 directions knows you need crucial pieces of information to get good results: a starting point and a destination. Mike Quigley California Department of Public Health 27

28 What is your starting point and destination? Set a baseline for measuring improvement Set a measurable goal Set quality improvement strategies Get credit! 50 POINTS of MOC Part 4 through AAP online course EQIPP: Immunizations Source: HPVIQ.org California Department of Public Health 28

29 Assessment and Feedback Assessment and feedback strategy can improve vaccination delivery When providers are given an assessment of their current vaccination coverage, along with achievable goals, coverage improves California Department of Public Health 29

30 Implement Systems Strategies Vaccination-only visits Pre-visit huddles Provider prompts in EHR Check EHR and/or CAIR for recommended vaccines at every visit (sick or well) Schedule appointment for next dose same day Reminder/recall California Department of Public Health 30

31 RESOURCES AND EDUCATION MATERIALS FOR HCPS AND PARENTS California Department of Public Health 31

32 Educational Materials from CDPH California Department of Public Health 32 Order from LHD at bit.do/immunization

33 Educational Materials from CDPH California Department of Public Health 33 Order from LHD at bit.do/immunization

34 California Department of Public Health 34

35 Educational Materials from CDC California Department of Public Health 35

36 Educational Materials from CDC Available at: California Department of Public Health 36

37 How an office routinely recommends HPV vaccine. What do you say to parents who have HPV vaccine safety concerns? What do you say when parents ask about HPV vaccine side effects? #HowIRecommend California Department of Public Health 37

38 Resources for HCPs from American Cancer Society Steps for Increasing HPV Vaccination in Practice Action Guides for Small Private Practices Large Health Systems Physicians, PAs, and NPs Nurses and MAs Oral Health California Department of Public Health 38

39 Resources for HCPs from HPVIQ.org Background information Assessment and feedback tools Communication training tools California Department of Public Health 39

40 What can Healthcare Providers do? Make an effective recommendation for HPV vaccination as cancer prevention for every 11- or 12- year old patient Assess HPV vaccine coverage for each provider in your practice and develop an office-wide strategy to improve it Engage the ENTIRE practice in committing to improve HPV vaccine coverage Implement systems strategies to improve HPV vaccine coverage California Department of Public Health 40

41 Thank you! Phone: California Department of Public Health 41