Dr. Katharine Garnier, M.D. UMDNJ-SOM 52 E Laurel Rd. , ste 2100 - PDF document

8/19/2013 Dr. Katharine Garnier, M.D. UMDNJ-SOM 52 E Laurel Rd. , ste 2100 Stratford, N.J. 08084 garnieka@UMDNJ.edu 856-566-2864 (p) 856-566-6188 (f) 1

8/19/2013 OBJECTIVES: review • Vaccine preventable diseases • Immunization rates • goals quantify • Barriers • partnerships define Rashes Chicken pox menigococcal measles 2

8/19/2013 Hepatitis A Hepatitis B icterus Respiratory illnesses---- pertussis influenza pneumococcal 3

8/19/2013 polio HPV shingles tetanus diptheria HPV TRAVEL MEDICINE Japanese Rabies Encephalitis Typhoid Yellow fever Tick-borne encephalitis 4

8/19/2013  Adolescents to adult- HPV, Meningococcal, Influenza annually, Tdap/Td, MMRV, Hepatitis A and B, (consider polio booster and pneumococcal for special groups).  >60 ---shingles vaccine additionally  >65- --pneumococcal vaccine, influenza, shingles, (tdap/td possibly).  Special risk groups have additional recommendations Annually in the U.S. vaccine preventable diseases claim 500 children and 50,000 adults lives 5

8/19/2013  N.J. has an overall immunization rate of 86.9% in children…….. which makes us 45 th in the U.S.  N. J. ranks 6 th WORST in pneumococcal rates  Tdap rates are only 8.2%, and only 20.3% in HCP  Pneumococcal rates for under 65 are 18.5%, and over 65 only at 59.7%, with no change from 2009  Herpes zoster is at 14.4%  Influenza rates for >65 increased from 61.3% to 78.1% since 2009, still under recommended levels. Tdap increased 1.9-8.2% Zoster increased 4.4-14.4% HPV, at least one shot, increased from 3.6- 20.7% 6

8/19/2013 Other vaccination rates have remained unchanged since 2009, less then 70%  Lack of education about vaccines, indications, safety and needs  No memory of severe diseases prevented  Fear of vaccination safety  Lack of access --hours available for vaccinations --no insurance  Costs 7

8/19/2013  Storage requirements  Expiration of vaccines  Multi-dose vials  Hours available  Cost --boxes of 5 or 10 vaccines for small practices --reimbursement issues  Staffing  Education of the public, AND HCP  Increased access --work place --pharmacies --hospitals --extended care facilities --urgent care centers  Increased promotion- --professional associations --public and private advertising 8

8/19/2013 Increase vaccination rates WITHIN our practices  ---with manual/EMR recall/reminders systems ---utilize the NJIIS, include your adult patients also Institute standing orders for all patient encounters  Remove financial issues  ---by partnering with manufacturers for coding and purchasing agreements ---join cooperative purchasing groups ---Streamline billing by EMR implementation Assessment of your own practice immunization rates  Encourage HCP to get immunized   Development of a Vaccine For Uninsured Adults ..(VFUA) similar to VFC program  Cover under Medicare part B  Require insurers to cover adult vaccinations 10 billion dollars annually spent in health care costs related to vaccine preventable diseases!! 9

8/19/2013  MMWR 2/3/2012 61(04) 66-72  CDC National Health Interview Survey, 2010  Trust for America’s Health  ACIP  Children’s Hospital of Philadelphia Vaccine Education Center  Children’s Hospital of Philadelphia Vaccine Resources: websites 10

8/19/2013  Discuss the pharmacist's role in public health and the immunization neighborhood  Explain the role of, and procedures for, pharmacies in administering vaccinations;  Discuss best practices for collaboration between pharmacists and other immunization stakeholders 1

8/19/2013 Vaccination coverage for target groups by vaccine, age, and high-risk status, NHIS 2010* Age Based *Data source: 2010 National Health Interview Survey. CDC. Adult Vaccination Coverage — United States, 2010. MMWR 2012; 61(04);66-72. Coverage for vaccines recommended for older adults, NHIS 2010* Vaccine Coverage % Influenza (65+) 66.4% (CI 64.4 – 68.5) Pneumococcal (ppv23) (65+) 59.7% (CI 58.0 – 61.4) Zoster (60+) 14.4% (CI 13.7 – 16)** *Data source: 2010 National Health Interview Survey. CDC. Adult Vaccination Coverage — United States, 2010. MMWR 2012; 61(04);66-72. ** Statistically higher than 2009 coverage rates 2

8/19/2013 Influenza Vaccination Coverage Among Adults 18-64 Years who Reported Selected Chronic Conditions, BRFSS 2007 – 2011 Source: CDC, Preliminary unpublished data, 2012 Place of Influenza Vaccination Among Adults – United States, 2010-11 Season, BRFSS Survey MMWR June 17, 2011 3

8/19/2013 “Immunization Neighborhood” • Purpose: – Collaboration, coordination and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine preventable diseases. "We need a neighborhood that is safe and healthy, and not at war." – Dr. Anne Schuchat, Director of the National Center for Immunization and Respiratory Diseases (CDC) 4

8/19/2013 Targeting Opportunities for Pharmacists Roles of Pharmacists in Immunization Advocacy • Pharmacist as advocate – Educating and motivating patients Supports multi-faceted • Pharmacist as facilitator role of pharmacists – Hosting others who vaccinate across the life cycle. • Pharmacist as immunizer – Giving vaccinations yourself 1996, APhA House of Delegates 5

8/19/2013 Pharmacist Immunization Factoids More than 185,000 Pharmacy profession pharmacists trained Pharmacists are an estimated spend on to administer accessible and marketing / patient vaccines communication in 2010- valued partner on 11 season is $40 million the patient’s health care team All 50 states, DC ,and PR authorize pharmacists to Pharmacies can target administer vaccines at immunization messages to some level patients using patient data and medication markers Pharmacists are trained to administer vaccines More than 96% of pharmacies across the lifespan are computerized and use and are helping computers in practice Property of APhA patients complete management vaccine series Improving medication use…Advancing patient care  Access, proximity, extended hours  especially when others are closed  Equivalent of US population enters a pharmacy each week  Ability to identify high-risk patients easily based upon their medications  Public’s trust - Gallup Poll / enthusiastic acceptance  Message dissemination vehicles  Practice guided by nationally adopted guidelines  Support completion of multi-dose vaccines (ie: HPV, etc)  Knowledgeable vaccine resource  - Education / training  Ability to handle storage issues 6

8/19/2013 Targeting Messages: Prescription Vial Auxiliary Labels • Need for influenza & pneumococcal vaccines: – Heart Disease Digoxin, warfarin, nitrates – Lung Disease Theophylline, zafirlukast, steroids, chronic inhaler use – Diabetes Insulin, oral hypoglycemics – All > 65 y/o Any or none • Other vaccines? 2008v1-13 As an individual pharmacist, have or will you receive(d) an annual influenza vaccination? 2011 n=1936; 2012 n= 2280 7

8/19/2013 15 16 8

8/19/2013 What percentage of your patients provide you with a primary care provider to send their immunization information to? n= 1113 From the 1950’s…. 9

8/19/2013  HPV is a 3-dose series  Initial evaluation/education could be done by medical provider or the pharmacist  First dose administration could be provided by medical provider or the pharmacist  Remaining 2 doses could be provided by the pharmacist  Documentation sent to the medical provider 10

8/19/2013 Example 2: Tdap Practice • University of California San Diego (UCSD) Health System Tdap Cocooning Clinic • Staffed by pharmacists and student pharmacists with Dr. Elizabeth Rosenblum serving as supervising physician • Vaccinated household contacts and other close contacts of newborns • Vaccines provided at no cost • Provided >1,250 Tdap vaccinations • nearly 15% were hispanic • Was only cocooning clinic in San Diego County and only clinic to use pharmacists as sole provider • Challenges included: space, administrative support, and information systems • Received local media coverage http://www.pharmacist.com/AM/Template.cfm?Section=Pharmacist_Immuniz ation_Center1&CONTENTID=25537&TEMPLATE=/CM/ContentDisplay.cfm Pharmacists’ response to can you administer Tdap?: Need to move beyond “depends”… Parents (depends) Siblings (depends) Child (depends) Grandparents and Caretakers and other family others (depends) members (depends) 11

8/19/2013 Example 3: Integrating Combined Participant Percent* immunizations into diabetes management Flu, Foot and Eye *Diabetes Ten City Challenge (N=573) Averages thru Dec 31, 2007 Flu Vaccination Rates: NCQA (Commercial Accredited Plans): 49% DTCC Results: 65% % of Patients 100% 80% 60% Beginning 40% End 31-Dec-07 20% 0% Flu Foot Eye Lipid Shots Exams Exams Profiles The Diabetes Ten City Challenge: Interim Clinical and Humanistic Outcomes of a Multisite Community Pharmacy Diabetes Care Program. J Am Pharm Assoc . 2008 Mar-Apr;48:181 – 90. Why we do what we do… Source: Evan Marcus Rothholz, Born November 8, 2010 12

8/19/2013 Rx to our nation’s immunization initiative Adult Immunizations Adult Immunizations Posters Prescription Pad 13