Identifying Strategies for Improving Patient Counseling Regarding Vaccines

Transcription

1 Identifying Strategies for Improving Patient Counseling Regarding Vaccines Identifying Strategies for Improving Patient Counseling Regarding Vaccines Miranda Wilhelm, PharmD Clinical Associate Professor Department of Pharmacy Practice Southern Illinois University Edwardsville School of Pharmacy Edwardsville, Illinois Faculty and Staff Disclosures Miranda Wilhelm, PharmD, has the following relevant financial relationships with commercial interests to disclose: Speakers Bureau Merck Vaccines Carrie Koenigsfeld, PharmD, FAPhA, has the following relevant financial relationships with commercial interests to disclose: Speakers Bureau Merck Vaccines, Pfizer Vaccines Pharmacy Times Continuing Education Planning Staff: Dave Heckard; Maryjo Dixon, RPh; Dipti Desai, PharmD, RPh; Jyoti Arya, PharmD, RPh; Donna Fausak; and Susan Pordon have no financial relationships with commercial interests to disclose. An anonymous peer reviewer has been used as part of content validation and conflict resolution. The peer reviewer has no relevant financial relationships with commercial interests to disclose. The content of this symposium may include information regarding the use of products that may be inconsistent with, or outside the approved labeling for, these products in the United States. Pharmacists should note that the use of these products outside current approved labeling is considered experimental and are advised to consult the prescribing information for these products. This activity is funded by an educational grant from Sanofi Pasteur U.S. Learning Objectives At the completion of this activity, participants will be able to: Identify the epidemiology of vaccine-preventable diseases and factors associated with outbreaks Explore current vaccine guidelines for both pediatric and adult populations Examine the current burden that vaccine-preventable diseases have on the pediatric and adult populations as well as the health care system Explain the concept of quality measures and how they can be used to monitor immunization rates as well as incentivize health care providers Provide methods for improving patient counseling regarding vaccinations Vaccines Work! IAC website. Accessed 8/2/17. 1

2 Example of Outbreaks Due to Vaccine-Preventable Diseases United States United States United States Pertussis 176,918 cases Increasing incidence even after Tdap availability Measles 125 cases (8 states, 3 countries) Before vaccine, 3 4 million cases/y, deaths Meningococcal disease 25 cases (5 college campuses) Factors Associated With Outbreaks Vaccine refusal Incomplete vaccine series Intentionally unvaccinated due to personal beliefs Alternative vaccination schedules Too young to be vaccinated Waning immunity Perceived risk versus benefit No vaccine is available Pertussis Outbreak Trends. CDC website Accessed 8/31/17. MMWR. February 20, 2015;64(06); Measles history. CDC website. Accessed 7/18/17. Serogroup B Meningococcal Disease Outbreaks on US College Campuses. National Meningitis Association website. prevention information/serogroup b meningococcal disease/outbreaks/. Accessed 7/18/17. MMWR. February 20, 2015;64(06); California Measles Outbreak Example Vaccination Rates Children N=110 patients diagnosed Incomplete vaccine series (5 patients one dose, 7 patients two doses, 1 patient three doses) Intentionally unvaccinated due to personal beliefs (28 patients) Alternative vaccination schedules (1 patient) Unvaccinated unknown reason (8 patients) Too young to be vaccinated (12 patients) Unknown or unvaccinated status (47 patients) Immunoglobulin G seropositivity (1 patient) Vaccine MMR (1+) DTP/DTaP (3+) Polio (3+) Hib (3+) HepB (3+) Varicella (1+) PCV (4+) Rotavirus HepA (2+) MMWR. February 20, 2015;64(06); Figure Depicting Coverage with Individual Vaccines from the Inception of NIS, 1994 Through CDC website map.html#modalidstring_cdctable_0. Accessed 8/31/17. Vaccination Rates Adults CDC Schedule for Birth to 18 Years Disease Percent Goal Healthy People 2020 Hepatitis A, 19 years, total 9.0 Hepatitis B, 19 years, total 24.6 Herpes zoster, 60 years, total % HPV, years, female, total 41.6 HPV, years, male, total 10.1 Influenza, years, total % Influenza 65 years, total % Pneumococcal, years, high risk, total % Pneumococcal, 65 years, total % Tetanus w/ pertussis, 19 years, total 23.1 Williams W et al. MMWR. 2017;66(11):1 28; Healthy People website. objectives/topic/immunization and infectiousdiseases. Accessed 7/19/17. Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger. CDC website. 18yrs childcombined schedule.pdf. Accessed 7/18/17. 2

3 CDC Schedule for Birth to 18 Years Based on Medical Condition CDC Schedule for Adults (19 Years +) Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger Based on Medical Indication. CDC website. 18yrs child combined schedule.pdf. Accessed 7/18/17. Recommended Immunization Schedule for Adults Aged 19 Years or Older. CDC website combined schedule.pdf. Accessed 7/18/17. CDC Schedule for Adults (19 Years +) Based on Medical Condition Influenza Vaccination Updates for Live attenuated influenza vaccine, [LAIV, (FluMist)] will not be recommended for use during the influenza season. Inactivated influenza vaccine, trivalent (Afluria) may be used for persons aged 5 years consistent with FDA approved labeling. Inactivated influenza vaccine, quadrivalent (Afluria) has been approved and may be used for persons 18 years. Recombinant influenza vaccine, quadrivalent (Flublok) has been approved and may be used for persons 18 years. Both recombinant influenza vaccine, trivalent and quadrivalent (Flublok) will be available this year. Inactivated influenza vaccine, quadrivalent (FluLaval) has been approved may be used for persons 6 months of age. Recommended Immunization Schedule for Adults Aged 19 Years or Older Based on Medical Condition. CDC website schedule.pdf. Accessed 7/18/17. MMWR. Accessed 9/5/17. Influenza Vaccination Updates for Pregnant women may receive any licensed, recommended, age-appropriate influenza vaccine. For children receiving the influenza vaccine ages 6 months through 8 years: the date by which the child should have received 2 or more doses is July 1, The Vaccine Information Statement (VIS) has not been updated for this season; the date of last publication is 8/7/15. Viruses in the vaccine: A/Michigan/45/2015 (H1N1) pdm09 like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008 like virus. (The A/Michigan virus is different from last year.) Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013 like virus. (The A/Michigan virus is different from last year.) Vaccine Truth vs Myth MMWR. Accessed 9/5/17. 3

4 Misconceptions About Immunization Misconception: Better Hygiene and Sanitation Reduce Disease Better hygiene and sanitation reduce disease Vaccines do not work because vaccinated individuals sometimes get the disease Hot lots of vaccines are associated with adverse effects Reduced disease means vaccines are no longer needed Too many vaccines overwhelm the immune system Adjuvants and preservatives in vaccines cause medical problems Religious or philosophic objections Mandatory vaccination is interference by the government Concerns of safety or efficacy Vaccine-preventable diseases do not pose a serious health risk Better nutrition, antibiotics, less crowded living conditions, lower birth rates, sanitation Increased survival rates Reduced disease transmission Decreased the number of susceptible individuals Permanent drops in disease incidence coincide with widespread vaccine use Pertussis example United Kingdom, Japan, Sweden Misconception: Vaccines Do Not Work Because Vaccinated Individuals Sometimes Get the Disease No vaccine is 100% effective Vaccines take time to work Influenza example Misconception: Vaccines Do Not Work as Vaccinated Individuals Sometimes Get the Disease 1000 children 995 children vaccinated for measles 5 are unvaccinated for measles All children are exposed to measles and susceptible students become infected All 5 unvaccinated become infected People vaccinated vastly outnumber those who have not Measles example 7 children did not respond to the vaccine 100% of those unvaccinated were infected 7/12 or 58% of those vaccinated were infected Misconception: Hot Lots of Vaccines Are Associated With Adverse Effects Adverse Effects of Vaccines Surveillance systems lack information to establish causality between the vaccine and the adverse effect Sizes for vaccine lots vary significantly Inactivated vaccines Injection-site reactions (pain, redness, swelling) With or without fever Fatigue Headache Live attenuated vaccines Injection site reactions (pain, redness, swelling) Must replicate to work Mild form of the natural illness With or without fever Headache Rash Serious adverse effects are rare 4

5 Misconception: Reduced Disease Means Vaccines Are No Longer Needed Misconception: Too Many Vaccines Overwhelm the Immune System 30 years ago, children were protected against 8 diseases, utilizing more than 3000 immunologic components Today, children are protected against 14 diseases, utilizing 150 immunologic components What Would Happen If We Stopped Vaccinations? CDC website. gen/whatifstop.htm. Accessed 7/19/17. Too Many Vaccines? What you should know. Children s Hospital of Philadelphia Newsletter. Spring 2015;3. center/too many vaccines.pdf. Accessed 7/19/17. Misconception: Adjuvants and Preservatives in Vaccines Cause Medical Problems How to Address Misconceptions Suspending fluid Preservatives and stabilizers Adjuvants or enhancers Take time to listen Solicit and welcome questions Acknowledge benefits and risks Respect patient/parents authority Reduce the stress of shots Ingredients of Vaccines Fact Sheet. CDC website. gen/additives.htm. Accessed 7/19/17. Talking with Parents about Vaccines for Infants: Strategies for Health Care Professionals. CDC website. infants color office.pdf. Accessed 7/19/17. Evolving Health Care Landscape Payment shift from fee-for-service to value-based system Emphasis on quality of care provided and improvement in health outcomes Focus on preventive care rather than sick care Vaccine Quality Measures HEDIS 2017 Childhood Immunization Status Immunization for Adolescents Influenza Vaccination for Adults Ages 18 to 64 Years Influenza Vaccination for Adults Ages 65 Years and Older Pneumococcal Vaccination Status for Older Adults PQA No vaccine-related measures Centers for Medicare & Medicaid Services (CMS) Health plan measure includes annual influenza vaccine HEDIS, Healthcare Effectiveness Data and Information Set; PQA, Pharmacy Quality Alliance. Appleby J, et al. The Value and Imperative of Quality Measures for Adult Vaccines. Adult Vaccines Access Coalition. White Paper FINAL.pdf. Accessed 8/3/17. Summary Table of Measures, Product Lines and Changes. NCQA website Accessed 7/18/17. PQA Performance Measures. Pharmacy Quality Alliance website. Accessed 8/3/17. 5

6 Vaccine Quality Measures Medicare Star Ratings Identifying Immunization Candidates Health services Staying healthy: screening tests and vaccines Annual influenza vaccine Managing chronic conditions Member experience with health plan Member complaints and changes in the health plan s performance Health plan customer service Drug services Drug plan customer service Member complaints and change in the drug plan s performance Member experience with plan s drug services Drug safety and accuracy of drug pricing Patient Profile MTM Session Immunization Information System Age/DOB Medications Medical conditions Insurance plan Medications/conditions Vaccination status Vaccination status Star Ratings. Medicare website. a plan/staticpages/rating/planrating help.aspx?aspxautodetectcookiesupport=1. Accessed 7/18/17. Pharmacist s Role in Vaccinations Conclusion Provide Parent and Patient Counseling Pharmacists are among the most trusted professionals Community pharmacists enhance zoster vaccination rates Maximize Opportunities for Vaccination Offer Combination Vaccines Improve Accessibility to Vaccinations 93% of Americans live within 5 miles of a community pharmacy Use Electronic Medical Records Clinic pharmacists enhance zoster vaccination rates Incidence of vaccine-preventable diseases has significantly decreased due to immunization strategies for children and adults Outbreaks of vaccine-preventable disease can occur when vaccination rates decline Patients often cite a variety of myths about vaccines when giving reasons not to vaccinate Health care providers must continue interventions to increase vaccination rates to reduce morbidity and mortality of vaccine-preventable diseases Pharmacists can impact immunization rates by identifying patients who are vaccination candidates, using the patient profile or an MTM session Ventola CL. Immunization in the United States: Recommendations, Barriers, and Measures to Improve Compliance. P&T Jul; 41(7): J Am Pharm Assoc Jan Feb;53(1): NACDS Chain Pharmacy Industry Profile illustrates pharmacy value. Drug Topics. Sept 21, Available from: topics/news/modernmedicine/modern medicine news/nacds chain pharmacy industry profile?page=full. Accessed 8/31/17. Am J Med. 2013;126:832.e1 e6 Additional Resources Immunization Action Coalition Advisory Committee on Immunization Practices Medicare Star Ratings HEDIS Quality Measures easures.pdf?ver=