Objectives. SPMI Population. APNA 26th Annual Conference Session 2027: November 8, Miles 1. Immun wize: A Successful Collaborative Approach

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1 Immun wize: A Successful Collaborative Approach Leslie Miles, DNPc, PMHNP Leslie_Miles@byu.edu November 8, 12 Disclosure: Funding provided by MEG Grant from Brigham Young University There is no conflict of interest to disclose 1 Objectives Identify why the population is at higher risk for infectious diseases. Describe the barriers to receiving preventive immunizations. Identify intervention modes that can be effective to improve immunization rates in the population. 2 Population Medical needs neglected Negative impact of symptoms of disease on functioning Lack of knowledge Socioeconomic status Fractured provider system Decoux, M., 5; Druss, et al., 1; Druss, et al., 8; Hahm, Speliotis, & Bachman, 8; Hogan, et al., 1; Horvitz Lennon, et al., 6 3 Miles 1

2 Population Higher rates of morbidity, premature mortality Die on average 25 years earlier than the general population Medical illnesses prevalent Unrecognized, untreated, or poorly treated Medical providers often fail to address Health promotion and prevention activities Carney, Jones & Woolson, 6; Colton & Manderscheid, 6; Druss, et al., 1 Horvitz Lennon, et al., 6; Miller, Paschall, & Svendsen, 6; Parks, et al., 6. 4 Health Rates Smoking rates 4 85% (Dickey et al., 2; Kalman, Morisett, & George, 5: Leonard, et al., 1; McClave, et al., 1; U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration Office (5) Asthma and acute respiratory disorders Dickey, et al. 2 Substance abuse 26.9% U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration Office (5); Dickey et al., 2 Hepatitis B 5 times Rosenberg, et al., 1 Diabetes 4 times Bermudes, et al., 6; CDC, 12 ;Dixon, et al. ; Llorente & Urrutia, 6 5 Immunization Status & Barriers Convenience non probability sample clients n=392 WMH employees n= 172 Adult immunization questionnaire 17 items Immunization Rates Assess beliefs and knowledge Barrier identification Miles 2

3 Immunization Records % 24.4% Record 7 MMR MMR MMR Booster 7 Tdap Td CDC Tdap CDC Tdap Miles 3

4 7 Pneumococcal Pneumococcal CDC Targets Pneumococcal 35 Herpes Zoster CDC Herpes Zoster Hepatitis Hepatitis Aepatitis A CDC Hepatitis A 12 Miles 4

5 Hepatitis B CDC Hepatitis B Annual Influenza Flu CDC Baseline Survey Immunization Questionnaire Beliefs: Important for adults to receive immunizations 84.4% strongly agree or agree Immunizations are safe and prevent disease 84% strongly agree or agree Behaviors 56.6% interested in receiving information 56.8% interested in having their immunization status assessed 58.4% would like to receive their immunizations at WMH. 15 Miles 5

6 Barrier Themes Why did you choose to not receive immunizations? Lack of awareness/ knowledge 42.22% Accessibility 16.29% Personal Cost 13.3% Fears 1.37% Complacency 1.37% Not recommended by doctor 1.5% Other 5.92% 16 Intervention Strategies Collaboration of Agencies 17 Lack of Awareness/ Knowledge Patient education Education groups 5 sessions Flyers & Posters Newsletters Staff Wellness Meds Only Clubhouse Nurses/Staff 18 Miles 6

7 Physician Recommendation Identified medical providers in community 1 week WMH nurse collected data Letter to community medical providers 95 Goal: Increased awareness to local providers and support for immunization clinics 19 Expanding access WMH site clinics Targeted times Banking Days Day treatment Employee inclusion Vouchers Accessibility Voucher Clients are given a voucher for immunizations that contains their Medicaid and Medicare billing information. This voucher can be utilized at any county health department immunization clinic to receive vaccine free of charge 21 Miles 7

8 Cost No cost to clients UCHD Clinic (2 nurses) No extra personnel costs Reimbursement (Medicaid/Medicare) Free vaccine as available (HPV/Varicella) Other support to clinics WMH Space/Computer BYU Nursing students (2 3) Project facilitator Clients (Logistics) 22 Personal Health Record Utah Statewide Immunization Information System (USIIS) WMH clinic site designation Collection of data Reminder system Personal immunization records Updated immunization records sent to clients with a reminder of next clinic Distribute at day treatments Mailing 23 Immunization Clinics Project Facilitator/WMH Coordinate clinic schedules and support personnel Medicaid/Medicare billing information BYU Nursing Students/Volunteers Intake & initial answering of questions USIIS information sheet UCHD Personnel Education Provide assessment & vaccines Data entry to USIIS 24 Miles 8

9 Outcomes *Sept/Oct 12 Data Not Included* USIIS 358 enrolled/ 4 population Reached 8.5% 7 Clinic Dates 129 served 3 sites 2 sites currently 2 4 hours/each clinic Vouchers 229 / Vaccines Flu Hepatitis A Hepatitis B Twinrix (3) MMR Pneumococcal TDAP 16 25/17 c 14c 233/24c Patient Satisfaction Survey Up to date Immunizations Belief 59.5% 75.9% Follow up Immunizations Copy Immunizations/WMH staff/flyers/mailed reminder/ newsletters Beliefs Safe and prevent disease 84% 88.5% Important for adults to receive 84.4% 92.3% Immunizations at WMH 58.4% 9.4% Convenient to receive at WMH 92.3% 26 Conclusion Partnership WMH & UCHD & BYU Elimination of barriers Sensitivity to needs Simple Low Cost Marketing Model for preventive immunization care 27 Miles 9

10 References Bermudes, R. A., Keck, P.E. & Welge, J.A. (6). The prevalence of metabolic syndrome in psychiatric inpatients with primary psychotic and mood disorders. Psychosomatics, 47(6), Carney, C.P., Jones, L., & Woolson, R.F. (6). Medical comorbidity in women and men with schizophrenia: A population based controlled study. Journal of General Internal Medicine, 21, doi:1.1111/j Centers for Disease Control and Prevention (12, February). Advisory committee on immunization practices morbidity and mortality weekly report: Recommended adult immunization schedule. Retrieved from Centers for Disease Control and Prevention (12). March flu vaccination coverage: United States, Influenza season. Retrieved from survey march12.htm Centers for Disease Control and Prevention (8). Vaccination coverage among U.S. adults: National immunization survey. Retrieved from adult summer 7.pdf Colton C.W. & Manderscheid, R.W. (6). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prevention Chronic Disease, 3, A42. Decoux, M. (5). Acute versus primary care: the health care decision making process for individuals with severe mental illness. Issues in Mental Health Nursing, 26, Dickey, B., Normand, S. T., Weiss, R. D., Drake, R. E., & Azeni, H. (2). Medical morbidity, mental illness and substance abuse disorders. Psychiatric Services, 53(7), Dixon, L. Weiden, P.J., Delahanty J., Goldberg, R., Postrado, L., Lucksted, A., & Lehman, A. (). Prevalence and correlates of diabetes in national schizophrenia samples. Schizophrenia Bulletin, 26, Druss, B. G., Rohrbaugh, R. M., Levinson, C. M., & Rosenheck, R. A. (1). Integrated medical care for patients with serious psychiatric illness: A randomized trial. Archives of General Psychiatry, 58(9), Druss, B. G., Marcus, S. C., Campbell, J., Cuffel, B., Harnett, J., Ingoglia, C., & Mauer, B. (8). Medical services for clients in community mental health centers: Results for a national survey. Psychiatric Services, 59(8), Hahm, H. C., Speliotis, A. E., & Bachman, S. S. (8). Failure to receive health care among people with mental illness: Theory and implications. Journal of Social Work in Disability & Rehabilitation, 7(2), doi 1.18/ Hogan, M. F., Sederer, L. I., Smith, T. E., & Nossel, I. R. (1). Making room for mental health in the medical home. Preventing Chronic Disease 7(6), A132. Horvitz Lennon, M., Kilbourne, A. M., & Pincus, H. A. (6). From silos to bridges: Meeting the general health care needs of adults with severe mental illness. Health Affairs, 25(3), doi: /hlthaff Kalman, G.D., Morisette, S. B., & George, T. P. (5). Comorbidity of smoking in patients with psychiatric and substance abuse disorders. American Journal of Addiction, 14, doi:1.18/ Kessler, R.C., Chiu W.T., Demler O., Walters E.E. Prevalence, severity, and comorbidity of twelve month DSM IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 5 Jun;62(6): Leonard, S., Adler, L. E., Benhammnou, K., Berger, R., Breese, C.R., Drebing, C., Freedman, R. (1). Smoking and mental illness. Pharmacology Biochemistry and Behavior, 7(4), McClave, A. K., McKnight Eily, L. R., Davis, S. P., & Dube, S. R. (1). Smoking characteristics of adults with selected lifetime mental illnesses: Results from the 7 national health interview survey. American Journal of Public Health, 1(12), Llorente, M.D. & Urrutia, V. (6). Diabetes, psychiatric disorder, and the metabolic effects of antipsychotic medications. Clinical Diabetes, 24(1), Miller, B. J., Paschall, C. B., & Svendsen, D. P. (6). Mortality and medical comorbidity among patients with serious mental illness. Psychiatric Services, 57(1), Miller, C. L., Druss, B. G., Dombrowski, E. A., & Rosenheck, R. A. (3). Barriers to primary medical care among patients at a community mental health center. Psychiatric Services, 54(8), Parks, J., Svendsen, D., Singer, P., & Foti, M. (6). Morbidity and mortality in people with severe mental illness. National Association of State Mental Health Program Directors Medical Directors Council, Alexandria: VA Rosenberg, S.D., Goodman, L.A., Osher, F.C., Swartz, M.S., Essock, S.M., Butterfield, M. I. Constantine, N.T., Woldford, G.L. & Salyers, M.P. (1). Prevalence of HIV, hepatitis B and hepatitis C in people with severe mental illness. American Journal of Public Health, 91(1), Tratnack, S. A., & Kane, C. (1). Preventive health screenings in a clubhouse setting for persons with serious mental illness. The American Journal for Nurse Practitioners, 14(4), Utah Department of Health (7). Utah statewide immunization information system: Desktop reference. Retrieved from U.S. Department of Health and Human Services Healthy People 11 Healthy People : Immunization and Infectious Diseases(1). Healthy People : Immunization and Infectious Diseases. Retrieved from U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration Office (5). National Survey on Drug Use and Health: National results. Retrieved from 29 Miles 1