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