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
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UMDNJ-SOM 52 E Laurel Rd. , ste 2100 Stratford, N.J. 08084 garnieka@UMDNJ.edu 856-566-2864 (p) 856-566-6188 (f)
8/19/2013 2 review • Vaccine preventable diseases quantify
define
measles menigococcal Chicken pox
Rashes
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pertussis influenza pneumococcal
Respiratory illnesses----
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shingles polio HPV tetanus HPV diptheria
TRAVEL MEDICINE Japanese Encephalitis Rabies Typhoid Yellow fever Tick-borne encephalitis
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Adolescents to adult-
HPV, Meningococcal, Influenza annually, Tdap/Td, MMRV, Hepatitis A and B, (consider polio booster and pneumococcal for special groups).
shingles, (tdap/td possibly).
recommendations Annually in the U.S. vaccine preventable diseases claim 500 children and 50,000 adults lives
8/19/2013 6 N.J. has an overall immunization rate of 86.9%
in children……..which makes us 45th in the U.S.
N. J. ranks 6th 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
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%
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Lack of education about vaccines, indications,
safety and needs
No memory of severe diseases prevented Fear of vaccination safety Lack of access
Costs
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Storage requirements Expiration of vaccines Multi-dose vials Hours available Cost
Staffing
Education of the public, AND HCP Increased access
Increased promotion-
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Increase vaccination rates WITHIN our practices
Institute standing orders for all patient encounters
Remove financial issues
purchasing agreements
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!!
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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
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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
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Vaccination coverage for target groups by vaccine, age, and high-risk status, NHIS 2010*
*Data source: 2010 National Health Interview Survey. CDC. Adult Vaccination Coverage — United States, 2010. MMWR 2012; 61(04);66-72.
Age Based
Coverage for vaccines recommended for
*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
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)**
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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
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– Collaboration, coordination and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine preventable diseases.
– Dr. Anne Schuchat, Director of the National Center for Immunization and Respiratory Diseases (CDC)
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Roles of Pharmacists in Immunization Advocacy
– Educating and motivating patients
– Hosting others who vaccinate
– Giving vaccinations yourself
1996, APhA House of Delegates
Supports multi-faceted role of pharmacists across the life cycle.
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More than 185,000 pharmacists trained to administer vaccines
All 50 states, DC ,and PR authorize pharmacists to administer vaccines at some level Pharmacists are trained to administer vaccines across the lifespan and are helping patients complete vaccine series
More than 96% of pharmacies are computerized and use computers in practice management
Pharmacies can target immunization messages to patients using patient data and medication markers
Pharmacy profession estimated spend on marketing / patient communication in 2010- 11 season is $40 million
Pharmacists are an accessible and valued partner on the patient’s health care team
Property of APhA
Access, proximity, extended hours
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
Improving medication use…Advancing patient care
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Prescription Vial Auxiliary Labels
2008v1-13
– Heart Disease Digoxin, warfarin, nitrates – Lung Disease Theophylline, zafirlukast, steroids, chronic inhaler use – Diabetes Insulin, oral hypoglycemics – All > 65 y/o Any or none
As an individual pharmacist, have or will you receive(d) an annual influenza vaccination?
2011 n=1936; 2012 n= 2280
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15 16
8/19/2013 9 What percentage of your patients provide you with a primary care provider to send their immunization information to? n= 1113
From the 1950’s….
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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
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Example 2: Tdap Practice
http://www.pharmacist.com/AM/Template.cfm?Section=Pharmacist_Immuniz ation_Center1&CONTENTID=25537&TEMPLATE=/CM/ContentDisplay.cfm
Diego (UCSD) Health System Tdap Cocooning Clinic
pharmacists with Dr. Elizabeth Rosenblum serving as supervising physician
close contacts of newborns
County and only clinic to use pharmacists as sole provider
support, and information systems
Pharmacists’ response to can you administer Tdap?:
Parents (depends) Siblings (depends)
Grandparents and
members (depends)
Caretakers and
Child (depends)
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Combined Participant Percent* Flu, Foot and Eye
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.
0% 20% 40% 60% 80% 100% Flu Shots Foot Exams Eye Exams Lipid Profiles
% of Patients
Beginning End 31-Dec-07
*Diabetes Ten City Challenge (N=573) Averages thru Dec 31, 2007 Flu Vaccination Rates: NCQA (Commercial Accredited Plans): 49% DTCC Results: 65% Example 3: Integrating immunizations into diabetes management
Source: Evan Marcus Rothholz, Born November 8, 2010
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Adult Immunizations Posters Adult Immunizations Prescription Pad
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Mitchel C. Rothholz, RPh, MBA Chief Strategy Officer American Pharmacists Association 2215 Constitution Ave, NW Washington, DC 20037 (w) 202-429-7549 (FAX) 202-429-6300 (cell) 202-497-5350 email: mrothholz@aphanet.org