Improving Your Adolescent Vaccination Rates Todd Wolynn MD OP User Conference Atlantic City, NJ Thur...
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Transcript of Improving Your Adolescent Vaccination Rates Todd Wolynn MD OP User Conference Atlantic City, NJ Thur...
Improving Your Adolescent Vaccination Rates
Todd Wolynn MDOP User Conference
Atlantic City, NJ Thur 4/23/15 1:15P-2:15P
Todd Wolynn MD, MMM, IBCLC, FAAP
Kids Plus PediatricsBreastfeeding Center of PittsburghNational Breastfeeding Center
Vaccines: Research, Logistics, Management, Contracting and Policy
Immunizations, Breastfeeding Advocacy,Pediatric Sleep and Practice Management
Disclosures
• Board Member: Connexin Software (OP)• Consultant/Speaker: Merck & Sanofi Pasteur• Medical Director of Atlantic Health Partners
Please join SOAPM and PPMA You, your Staff, Families and Patients will be Better for it!
PSA: The Best $30 you’ll ever spend!
Improving Adolescent Vaccine Rates
I. The Core Adol Vaccines: Tdap, Mening, HPVII. Offering a Vaccine
Know the Audience, the Disease and the Data
Strength of Recommendation – it CRITICALIII. Multi-dose Regimens and the elusive Patient
Scheduling, Tracking, Recall and …IV. Practice CultureV. Use of MediaVI. GamificationVII. Resources
Registries, SchoolVIII. No Missed Opportunities
10 Great Public Health Achievements 2001-2010
1. Vaccine-Preventable Diseases2. Prevention and Control of Infections Diseases3. Tobacco Control4. Maternal and Infant Health5. Motor Vehicle Safety6. Cardiovascular Disease Prevention7. Occupational Safety8. Cancer Prevention9. Childhood Lead Poisoning Prevention10. Public Health Preparedness and Response
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a5.htm
10 Great Public Health Achievements 1900-1999
1. Immunizations2. Motor Vehicle Safety3. Workplace Safety4. Control of Infectious Diseases5. Declines in Deaths from Heart Disease & Stroke6. Safer and Healthier Foods7. Healthier Mothers and Babies8. Family Planning9. Fluoridation of Drinking Water10. Tobacco as a Health Hazard
http://www.cdc.gov/about/history/tengpha.htm
Characteristics of Adolescence
• Rapid Growth• Concern for their Body• Prefer being with Friends over Family• Quick to Disagree with Parents• Feeling of Invincibility• Frustrated, Anxious, Moody• Risk Taking• Sexual Curiosity
Stages of Adolescent Development; http://www.kidsgrowth.com/resources/articledetail.cfm?id=1140
Increasing demand for vaccines
• Client reminder/recall systems• Multicomponent interventions that include
education• Vaccination requirements for child care, school
and college attendance• Communitywide education only• Clinic-based education only• Client or family incentives• Client-held medical records
https://www2.aap.org/immunization/pediatricians/pdf/ImmunizationofAdolescents_nfid.pdf
Enhancing access to vaccination
• Expanding access in medical or public health clinical settings
• Vaccination programs in Women, Infants and Children (WIC) settings
• Vaccination programs in schools• Vaccination programs in child care centers• Vaccinations via Urgent Care and RBC• Vaccinations via Pharmacists• Via VNA, etc
https://www2.aap.org/immunization/pediatricians/pdf/ImmunizationofAdolescents_nfid.pdf
Provider-based interventions
• Provider reminder/recall• Assessment and feedback for vaccination
providers• Standing orders• Provider education only
https://www2.aap.org/immunization/pediatricians/pdf/ImmunizationofAdolescents_nfid.pdf
State-based Changes
• Legislated Exemptions– Medical– Religious – Philosophical
https://www2.aap.org/immunization/pediatricians/pdf/ImmunizationofAdolescents_nfid.pdf
Estimated vaccination coverage with selected vaccines and doses among adolescents aged 13–17 years, by survey year
National Immunization Survey-Teen, United States, 2006–2013
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6329a4.htm
Let’s Talk
Tdap
Let’s Talk
MCV
Let’s Talk
HPV
Common WARTS
HPV: 1, 2, 4
HPV: 1, 2, 4, 26, 27, 29, 41, 57
Over 100 of different HPV Types Identified
No Symptoms
PrecancerousLesions DEATH
HPV can cause:
CommonWarts Ano-Genital
Warts CANCER
> 150 Different
Types
~ 6 Types Cause
Ano-Genital Warts
HPV: 6 & 11
Cause 90% !
~ 40 Types Cause
CANCER
HPV: 16 & 18
cause the bulk
DEATHS> 6,000
HPV can be passed even when
an infected person has no signs or symptoms.
8 in 10 people in the U.S. WILL BE INFECTED
with HPV in their lifetime
Cervical Cancer
Anal Cancer
Oral Cancer
Vulvar Cancer
Vaginal Cancer
Genital Warts
Cervical Precancerous Lesions
Vulvar Precancerous Lesions
Vaginal Precancerous LesionsPenile Cancer
low grade cervical dysplasia
Genital Warts
High-grade cervical dysplasia
Cervical cancer
U.S. HPV-related Infections and Disease
79 million people currently infected 14 million people newly infected/yr
6,000+ Deaths/yr
~ 6,350
Oral cancer
VaginalCancer
Vulvar Cancer
~ 280,500
~ 1 million
~2,020
~2,115
~12,340
~ 1.1 million
Anal cancer
~ 6,700
What is the best way to be Protected from HPV?
Immunization
HPV Immunization Facts, Myths
and Questions
Why Immunize Against HPV?
Cancer Prevention !Disease Prevention
It is Effective
It is Safe
HPV Immunization Facts
HPV4 protects against HPV Types: 6,11,16 & 18
3 Doses: Day#1→ 2mo→ 6mo
Starting Age: 9yr, routine 11-12 years old
Gender: Girls and Boys
HPV Immunization FactsTop Five Responses Why Parents Didn’t Immunize Daughters
It’s Not Necessary19%
It Wasn’t Recommended14%
Safety Concerns13%
Lack of Disease Knowledge12%
Daughter Not Sexually Active 10%
(2012 National Immunizations Survey)
Is Sexual Intercourse necessaryto become infected ?
NO
Is the HPV Immunization Safe?
YES
Is the HPV Immunization routinely recommended age to start at 11-12 years old?
YES…but can start as early as 9 years old
Is it better to Wait to Childrenare Older to receive the
HPV Immunization?
No
Does HPV Immunization cause promiscuity?
No
HPV 3 dose in 2013completion rate for girls ages
13-17 years old?
a. 38%
b. 55%
c. 85%
HPV Immunization
Prevents CancerPrevents Disease
Must be given PRIOR to exposureIs SAFE
Tools to Impact Adolescent
Immunization
Vaccine Registries
IIS – Immunization Information SystemsPA SIIS - Pennsylvania Statewide ISS
-Electronic Capture, Secure -Meet National Immunization Goals - Identify pts coming due or overdue -Access to Centralized Database
Office Processes
• Make next HPV Appointment as they leave from their HPV #1 and #2 doses.
• Provided them with a Reminder Card or Reminder Device
• Ask them to enter the next appointment into their smart phone or other calendar.
• Recall those due with HPV – Phone, Email, Text
Missed Opportunities
• Although all most healthcare contacts could result in vaccination, adolescents are most likely to be immunized at preventative care visits– Problematic.
• Pediatricians and family practitioners are far less likely to review immunization records when adolescents visit the office for acute health complaints, and fewer still use these opportunities to administer vaccines.
Schaffer SJ, Humiston SG, Shone LP, Averhoff FM, Szilagyi PG. Adolescent immunization practices: a national survey of US physicians. Arch Pediatr Adolesc Med. 2001;155:566-571.
Electronic Health Records
• Help drive Office Processes • Internal Reminders• Reports on queries • Can structure recalls• Can deliver recalls• Optimizes Vaccine Inventory Management
Vaccine Forecasting
Vaccine Logic
Vaccine Status Recall Report for HPV (Teenagers)
● Run the Patient Demographics Report● Run the Vaccine Status Recall with the
following criteria:○ Forecast Status = Behind or Due○ Vaccine Group = HPV○ Recall date = Today○ Click on Search to Run Report
● You may Send Messages through the Patient Message eXchange
COMMUNICATION
Vaccine Office Culture
T. Wolynn 2013
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Trust
• Of Parents who believed that vaccines were not safe, the decision to vaccinate was significantly influenced by a health care provider vs parents’ not influenced by a health care provider (74.4% vs 50.3%; estimated difference: 24.1%).
Association Between Health Care Providers’ Influence on Parents Who Have Concerns About Vaccine Safety and Vaccination Coverage Philip J. Smith, PhD, Allison M. Kennedy, MPH, Karen Wooten, MA, Deborah A. Gust, PhD, MPH, Larry K. Pickering, MD PEDIATRICS Volume 118, Number 5, November 2006 e1287
Bonded Relationship
Social Media: Uncharted Territory
• Websites• Blogs• FaceBook• Twitter• Instagram• Piniterest• YouTube, Vimeo
11 min: Breastfeeding Health + Savings
X
50 Pts
200 Pts
500 Pts
Gamification
Badging
Thank you
Todd Wolynn MD, MMM, IBCLC
DrToddWo