THE NEVADA ADULT IMMUNIZATION Prepared by: Lily Davalos MPH Intern - PowerPoint PPT Presentation

THE NEVADA ADULT IMMUNIZATION Prepared by: Lily Davalos MPH Intern PROVIDER SURVEY: AN ANALYSIS Immunize Nevada

SURVEY BACKGROUND  The intent of the online survey is to better understand the attitudes, behaviors and perceived barriers for immunization providers  The findings of this survey will be used to create a toolkit that provides tools and resources to implement adult immunization best practices across the state  Survey was initially released on May 6, 2016 and closed on June 13, 2016  A total of 195 providers participated in the survey

METHODS  Participant Recruitment  12 Health leaders of professional organizations were contacted via email to distribute the online survey to their members  Over 2,300 individual pharmacists were emailed directly  Survey data was analyzed using Microsoft Excel and SPSS  Certain open responses were recoded to existing response categories  Disclaimer: the data is self-reported

PARTICIPANT CHARACTERISTICS

PARTICIPANT CHARACTERISTICS  49.7% (N=97) were from Clark County and 24.6% (N=48) were from Washoe County  67.2% (N=132) identified as pharmacists  56.9% (N=111) of participants report working in pharmacies  73.85% (N=144) report daily regular contact with patients Participant Job Position 13 Other Physician Assistant (PA) 0 Physician (MD/DO) 5 Pharmacist 132 Office Support Staff 1 Office Manager 3 Nurse 34 Medical Assistant (MA) 1 Adminster 6 0 20 40 60 80 100 120 140

HEALTHCARE PROVIDER IMMUNIZATION PRACTICES  92.3% (N =180) report receiving a flu shot during the 2015-2016 flu season  The most common reason being they are “a member of a target group for vaccination”, 38.9% (N=75) Primary Reason for getting an Influenza Vaccine 0.56% N/A 7.20% Workplace mandate 9.40% Recommendation by CDC 20.50% Protect patients from illness 11.10% Protect Myself 8.30% Protect family members 38.90% I am a member of a target group for vaccination 3.90% Free/convenient access 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%

HEALTHCARE PROVIDER IMMUNIZATION PRACTICES  12 Participants (6.2%) indicated that they did not receive the influenza vaccine in the 2015-2016 flu season.  The most common reason being that there is a small chance of contracting influenza 33.3% (N=3) Reasons Not to Vaccinate Fear of needles 8.33% Not a workplace mandate 16.66% Philosophical or religious beliefs 0% Too expensive/no medical insurance 0.00% Inconvenience 24.99% Small chance of contracting influenza 33.32% Concern about adverse reactions 0% Flu vaccine is not effective for preventing influenza 8.33% Medical Contradiction 8.33% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%

CHARACTERISTICS OF MEDICAL CLINIC/HEALTH FACILITY

ON SITE VACCINATIONS 86.98% (N=147) of participants report that their medical facility provide on-site adult immunizations 34.48% (N=50) of participants strongly agree that their medical facility is completely stocked. Another 34.48% of participants agree with this statement “ My Medical clinic/ Health facility is completely stocked with on-site storage of CDC recommended vaccines for adults” I don’t know 2.07% Strongly Disagree 4.83% Disagree 24.15% Agree 34.48% Strongly Agree 34.48% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%

REGULARLY STOCKED VACCINES  Almost all participants indicated that their sites regularly stock influenza vaccine (96.6%)  Only 21.4% of participants indicated that their sites regularly stock the Hib Vaccine and 24.8% regularly stock MenB Don't Know 2.76% Hib 21.38% MenB 24.83% MenACWY 35.17% Twinrix 41.38% HepB 63.45% HepA 58.62% PPSV23 84.14% PCV13 84.14% MMR 60.69% Zoster 76.55% HPV 48.97% Varicella 42.07% Td/Tdap 90.34% Influenza 96.55% 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00%

INSURANCE TYPE According to participants, the most common insurance type accepted is Private Health insurance, at 77.9% (N=152) Insurance Type Other 19.49% Sliding Scale 11.79% Public health insurance 59.49% Private health insurance 77.95% Medicare – Fee for Service 34.36% Medicare Prescription Drug Plan (Part D) 65.64% Medicare Advantage Plan (Part C) 25.64% Medicare- Part B 62.56% Madicaid- Fee for service 55.90% Medicaid- Managed Care 55.90% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00%

MEDICAL FACILITY AND SECTION 317 Only 17.24% (N=25) of respondents claim that their facility participates in Section 317 Participation in 317 Program I don’t know 40.00% No 42.76% Yes 17.24% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00%

COMPLIANCE WITH CDC RECOMMENDATIONS AND PROCEDURES  95.35% (N=164) of participants claimed that they were aware of the CDC Vaccine Recommendations  82.07% (N=119) of respondents Strongly Agree that their medical clinic/ health facility is fully compliant with CDC recommended vaccine Storage and procedures  71.03% (N=103) of respondents Strongly Agree that they have been adequately trained on CDC Recommended Vaccine Storage and Handling procedures  69.66% (N=101) of respondents Strongly Aree that their Immunization staff has been adequately trained

VACCINE RECOMMENDATION AND REFERRALS

REVIEW OF VACCINATION STATUS OF ADULT PATIENTS 34.88% (N=60) of participants claim to review vaccination status on “Some Visits “ How often do you review Vaccination status Not part of my Scope of Practice 16.86% Never 4.07% Rarely 19.19% Some Visits 34.88% Most Visits 16.86% All Visits 8.14% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%

VACCINE SCREENING PROCEDURES AT MEDICAL/ HEALTH FACILITY Overall, most of the clinic/ health facilities report having have proper screening procedures “My Medical Clinic/Health facility has screening procedures of CDC recommended vaccines for adults I don’t know 11.05% Strongly Disagree 5.23% Disagree 14.53% Agree 38.37% Strongly Agree 30.81% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00%

NEVADA WEBIZ  79.05% (N=117) of respondents claim that their medical facility utilizes Nevada WebIZ.  However, 35.1% (N=2) of participants don’t know how current their patient’s immunization records are How Current the immunization health records are for adult patients I don’t know 35.14% Up-to-date for less than half of adult patients 12.16% Up-to-date for a majority of adult patients 21.62% Up-to-date for all adult patients 31.08% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%

HOW OFTEN ARE NEEDED VACCINES RECOMMENDED 33.14% (N=57) of participants reported that they always recommend the vaccines, and 33.72% (N=58) of participants recommend “Most of the time” If an adult patient needs a vaccine, how often do you recommend the vaccine to them? Not part of my scope of practice 13.37% Never 0.58% Rarely 3.49% Sometimes 15.70% Most of the time 33.72% Always 33.14% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%

REFERRALS FOR VACCINES THAT ARE NOT STOCKED  86.21% (N=125) of participants reported that they do refer patients to other providers when they do not stock the vaccine  The most common referral location is a pharmacy (69.6%, N= 87) Referral Sites for medical locations that do vaccinate Other 16.00% Pharmacy 69.60% Local Health Department 53.60% Hospital Owned Clinic 7.20% FQHC 6.40% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00%

VACCINE REFERRALS FOR SITES THAT DO NOT HAVE ON- SITE VACCINES  43.48% of respondents refer patient to other provider sites that provide adult vaccines  The most common referral location is a pharmacy (85.7%, N=6) Referral Sites for Non-Vaccinating Medical Facilities Other 0.00% Pharmacy 85.71% Local Health Department 42.86% Hospital Owned Clinic 28.47% FQHC 28.47% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00%

BARRIERS TO VACCINES AND HELPFUL RESOURCES

TOP5 MAJOR IMMUNIZATION CONCERNS FOR ADULT PATIENTS REPORTED BY PROVIDERS 1 Lack of Insurance 119 (70.41%) 2 Fear of Vaccine making them ill 94 (55.62%) 3 Believe Vaccine is not effective 75(44.38%) 4 Fear of Needles 67 (39.64%) 5 Doubts of vaccine safety 66 (39.05%)

PROVIDER BARRIERS TO UPDATING VACCINE RECORDS The most common perceived barrier reported by providers is that patients do not know their vaccination history, 71.62% (N= 106) Perceived Barrier to obtaining up-to-date adult vaccination records Other (please specify) 7.43% Not part of my scope of practice 15.54% Practice is not reimbursed for doing so 13.51% Taking adult immunization history is not mandated 18.24% Patients do not know their immunization history 71.62% Not prompted and/or facilitated by Electronic Health Records 25.68% prompts/system Not enough time 38.51% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

HELPFUL RESOURCES The material perceived to be most helpful for providers are factsheets for patients, 72.30% (N=107) Helpful Resources for Health Facility Other 9.46% Healthcare worker education materials 38.51% Resources for Spanish Speakers 34.46% Posters and flyers for your office 37.84% Factsheets for Patients 72.30% Patient Education Videos for Office 12.16% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%