Adult Immunizations and New York State Immunization Superheroes Sarah Hershey Adult and Adolescent Immunization Coordinator New York State Department of Health Bureau of Immunization 2 Adult Provider Visits 1
Overview of Adult Visits Purpose Why are these visits so important? o Adult immunization rates are very low o NYSIIS is under-utilized o Promote adult immunization awareness with providers, and their office staff. Encourage routine immunization assessment at every clinical encounter. Encourage strong immunization recommendations for all ACIP recommended adult vaccines. Encourage vaccines be administered or refer to a provider who administers the needed vaccine Encourage documentation of vaccines administered including entering into NYSIIS with the patient s consent 3 Overview of Available Resources 4 NYSDOH, Bureau of Immunization: o Adult Provider Visit Guidance Document o Initial Visit Form o Follow-up Visit Form o Adult Immunization Resource Guide o Adult Immunization Provider Toolkit o Healthcare Provider Letter 2
Overview of Resources (Continued) 5 Centers for Disease Control and Prevention: o Adult Vaccination Resources webpage: https://www.cdc.gov/vaccines/hcp/adults/index.html o Standards for Adult Immunization Practice webpage: https://www.cdc.gov/vaccines/hcp/adults/forpractice/standards/index.html o Advisory Committee on Immunization Practices webpage: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html Immunization Action Coalition: http://www.immunize.org/handouts/adultvaccination.asp Upcoming Resources Updates to the Adult Provider Visit Guidance document o Addition of resources that have been provided since the original guidance document was provided Group Adult Immunization Provider Visit guidance document o Information is a supplement to the original Adult Provider Visit Guidance document. o Group visits must meet all of the components of an Adult Visit for each provider who attends the group visit. o Follow-up visits for the group visits should be conducted on site. 6 3
Notable Barriers Identified 7 Provider refusal of a visit due to lack of time or because visits are not mandatory Providers resistant to use NYSIIS or believe EMR cannot communicate with NYSIIS Providers state policy decisions are made by the administration of the health system to which they belong, not at the practice level Difficulty scheduling follow-up visits Addressing Barriers Provider refusal: document attempts; if significant problem, notify your regional office or call central office NYSIIS resistance: review benefits of NYSIIS, explain that NYSIIS is working with all major EMRs and NYSIIS staff will work with providers to assure the data is transmitted to NYSIIS Policy not made at practice level: NYSDOH will pilot health systems outreach during the next contract year to discuss opportunities to increase adult immunizations and explore potential solutions. Difficulty scheduling follow-up visits: document attempts; if unsuccessful contact regional office staff for guidance. 8 4
Notable Achievements Attained 9 Assistance to providers regarding EMRs communicating with NYSIIS Assistance to providers to gain access to NYSIIS and begin input of patient vaccines administered Providers developing protocols for obtaining consent from adult patients to input vaccines administered into NYSIIS 10 Adult Immunization Coalitions 5
Review of What Was New 11 Coalition meetings at least once per quarter Coalition membership evaluation and recruitment of new members Coalition evidence-based intervention Document these activities on quarterly reports Notable Barriers Identified 12 Time and effort required Training needed on the topic of evidence-based interventions Difficulties recruiting new members 6
Addressing Barriers Time and effort needed: o Utilize community partners and other coalition members. Frances Butterfoss will also speak to this topic. Evidence-based intervention training: o Identify an adult immunization need in your community. o Consult the Community Guide for evidence-based interventions. o Consult your regional office staff or central office for assistance if needed. o There will be a webinar on this topic coming soon. Recruitment and retention: o Review membership and consider stakeholder groups that may not be represented. o Coalition interventions can also draw members interested in a particular project. o Frances Butterfoss will also speak to this topic. 13 Notable Achievements Attained 14 New coalitions were formed HPV education and vaccine administered at local colleges NYSIIS use assessment and provider education to increase provider awareness and emphasize the importance of NYSIIS Outreach to providers and community partners to provide education and resources to address an ongoing measles outbreak 7
15 Adult Immunization Superheroes Immunization Champions 16 Can be any adult immunization provider, such as: o Primary Care Providers o Pharmacists o Healthcare Facilities o Health Centers 8
Adult Immunization Champion: Example 1 Loretto Health and Rehabilitation: o Healthcare personnel influenza vaccination rates for 2017-2018 season were 92% Multiple communication modalities Incentives Staff who decline: watch an educational video with a post-test, are reminded of flu mask reg, and wear a red dot on name tag with decline on it as part of policy to protect staff and residents. 17 Loretto Continued 2016 resident influenza rates were 90%, and pneumococcal rates were 86% o Mid-August mailing to health care proxies regarding influenza vaccine o Administration check regularly with all units to make sure needed vaccines are being administered. o If resident or family refuse, administration speaks with them to assure they understand the importance of the vaccines. o Vaccine status of each new resident is reviewed on admission 18 9
Adult Immunization Champion: Example 2 19 Tarika James, MD, Chief Medical Officer for Long Island FQHC o Instituted standing orders to improve adult immunization rates o Since the policy was implemented in 2015: Pneumococcal immunization rates increased from 50% to 65-69% Influenza immunization rates increased from 40% to 50% AND.You! 20 You are your counties immunization champions! You know your counties needs best! You know the immunization stakeholders in your communities! You know what interventions your communities need most! 10
21 So Now What? What does this mean for 2019-2020? 22 Adult visits have provided valuable information for providers and are showing positive results Coalition interventions are increasing access to vaccine, and increasing awareness and use of NYSIIS Continue the great work you are doing! If you are encountering barriers, or have other questions or concerns, please reach out to your regional office or Sarah Hershey o (518) 473-4437; sarah.hershey@health.ny.gov 11
23 Questions? 12