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

THE NEVADA ADULT IMMUNIZATION PROVIDER SURVEY: AN ANALYSIS

Prepared by: Lily Davalos MPH Intern 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

6 1 34 3 1 132 5 13

20 40 60 80 100 120 140

Adminster Medical Assistant (MA) Nurse Office Manager Office Support Staff Pharmacist Physician (MD/DO) Physician Assistant (PA) Other

Participant Job Position

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)

3.90% 38.90% 8.30% 11.10% 20.50% 9.40% 7.20% 0.56%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%

Free/convenient access I am a member of a target group for vaccination Protect family members Protect Myself Protect patients from illness Recommendation by CDC Workplace mandate N/A

Primary Reason for getting an Influenza Vaccine

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)

8.33% 8.33% 0% 33.32% 24.99% 0.00% 0% 16.66% 8.33%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%

Medical Contradiction Flu vaccine is not effective for preventing influenza Concern about adverse reactions Small chance of contracting influenza Inconvenience Too expensive/no medical insurance Philosophical or religious beliefs Not a workplace mandate Fear of needles

Reasons Not to Vaccinate

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

34.48% 34.48% 24.15% 4.83% 2.07%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%

Strongly Agree Agree Disagree Strongly Disagree I don’t know

“ My Medical clinic/ Health facility is completely stocked with on-site storage of CDC recommended vaccines for adults”

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

96.55% 90.34% 42.07% 48.97% 76.55% 60.69% 84.14% 84.14% 58.62% 63.45% 41.38% 35.17% 24.83% 21.38% 2.76%

0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00%

Influenza Td/Tdap Varicella HPV Zoster MMR PCV13 PPSV23 HepA HepB Twinrix MenACWY MenB Hib Don't Know

INSURANCE TYPE

According to participants, the most common insurance type accepted is Private Health insurance, at 77.9% (N=152)

55.90% 55.90% 62.56% 25.64% 65.64% 34.36% 77.95% 59.49% 11.79% 19.49%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00%

Medicaid- Managed Care Madicaid- Fee for service Medicare- Part B Medicare Advantage Plan (Part C) Medicare Prescription Drug Plan (Part D) Medicare – Fee for Service Private health insurance Public health insurance Sliding Scale Other

Insurance Type

MEDICAL FACILITY AND SECTION 317

Only 17.24% (N=25) of respondents claim that their facility participates in Section 317

17.24% 42.76% 40.00%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00%

Yes No I don’t know

Participation in 317 Program

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 “

8.14% 16.86% 34.88% 19.19% 4.07% 16.86%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%

All Visits Most Visits Some Visits Rarely Never Not part of my Scope of Practice

How often do you review Vaccination status

VACCINE SCREENING PROCEDURES AT MEDICAL/ HEALTH FACILITY

30.81% 38.37% 14.53% 5.23% 11.05%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00%

Strongly Agree Agree Disagree Strongly Disagree I don’t know

“My Medical Clinic/Health facility has screening procedures of CDC recommended vaccines for adults

Overall, most of the clinic/ health facilities report having have proper screening procedures

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

31.08% 21.62% 12.16% 35.14%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%

Up-to-date for all adult patients Up-to-date for a majority of adult patients Up-to-date for less than half of adult patients I don’t know

How Current the immunization health records are for adult patients

HOW OFTEN ARE NEEDED VACCINES RECOMMENDED

33.14% 33.72% 15.70% 3.49% 0.58% 13.37%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%

Always Most of the time Sometimes Rarely Never Not part of my scope of practice

If an adult patient needs a vaccine, how often do you recommend the vaccine to them?

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”

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)

6.40% 7.20% 53.60% 69.60% 16.00%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00%

FQHC Hospital Owned Clinic Local Health Department Pharmacy Other

Referral Sites for medical locations that do vaccinate

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)

28.47% 28.47% 42.86% 85.71% 0.00%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00%

FQHC Hospital Owned Clinic Local Health Department Pharmacy Other

Referral Sites for Non-Vaccinating Medical Facilities

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)

38.51% 25.68% 71.62% 18.24% 13.51% 15.54% 7.43%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

Not enough time Not prompted and/or facilitated by Electronic Health Records prompts/system Patients do not know their immunization history Taking adult immunization history is not mandated Practice is not reimbursed for doing so Not part of my scope of practice Other (please specify)

Perceived Barrier to obtaining up-to-date adult vaccination records

HELPFUL RESOURCES

The material perceived to be most helpful for providers are factsheets for patients, 72.30% (N=107)

12.16% 72.30% 37.84% 34.46% 38.51% 9.46%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

Patient Education Videos for Office Factsheets for Patients Posters and flyers for your office Resources for Spanish Speakers Healthcare worker education materials Other

Helpful Resources for Health Facility

IMPLICATIONS

• Overall, most participants perceive that they are personally in

compliance with CDC vaccine recommendations, and that their health facility is aware of CDC recommended procedures

• Lack of insurance is the most commonly reported barrier to vaccination

for adult patients

• The highest reported barrier for maintaining up-to-date records is that

patients do not know their own immunization history

• Factsheets for patients would be the most helpful material at a health

facility

RECOMMENDED NEXT STEPS

• Create and distribute identified resources directly to providers
• Increase outreach efforts to inform the general public on Nevada

WebIZ and immunization documentation

• Will be included in the community toolkit
• Provide educational opportunities to vaccine providers on utilizing

Nevada WebIZ

• Will be included in the pharmacy toolkit
• Review and update the general referral process for providers
• Referral sheets will be created and included in the toolkit.

THANKS FOR LISTENING! QUESTIONS?