NVPO Webinar Series: Project Successes and Challenges

August 13, 2013

Welcome and Overview• Bruce Gellin, M.D., M.P.H.

• Shary M. Jones, Pharm.D., M.P.H., BCPS CDR—U.S. Public Health Service National Vaccine Program Office

• Alaysia Phillips, M.P.H.—JBS International, Inc.

Presenters• Michelle Nadow-Dorchester House

• Leslie Laurie-Tapestry Health

• Faith Lutsik-Jefferson County Health Department

• Drew Sacheli-Monroe County Health Department

Bruce G. Gellin, M.D., M.P.H.Deputy Assistant Secretary for Health and Director

National Vaccine Program OfficeU.S. Department of Health and Human Services

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Dorchester House Multi-Service Center

Patient Navigation to improve completion of the HPV vaccine series in low-income, minority adolescents

Project Successes• Built report of patients overdue for HPV vaccine

• Trained two navigators to call patients‒ Additional benefit: created MA champion for HPV completion by

involving her in the team

• Navigators are now calling patients for the whole pediatrics department

• Reduced % of patients ages 11-21 overdue for dose 2 or 3 of HPV vaccine from 16% to 12%

Challenges• Creating an accurate report of patients overdue for vaccine

• Patient outreach (correct phone numbers, languages)

• No-shows

• Ran out of HPV vaccine for two weeks

• System to track, reach out, and follow up with patients is time-consuming– Phone calls– Data entry

Lessons Learned/Best Practices• Call in the evening

• Multiple touches necessary

• Using clinical staff as navigators has advantages and disadvantages‒ More comfortable with patient contact ‒ Clinical knowledge – what is needed, making appropriate appointments‒ Takes time away from other clinical responsibilities

• Non-clinical staff requires more training and supervision

Evaluation/Measurable Outcomes

Individuals Reached Since Project Start

Female Male

11-17 18+ 11-17 18+

May 35 7 32 14

June 68 14 64 17

July 186 50 195 58

Evaluation/Measurable Outcomes• Since start of project:

– 554 letters sent

– 495 phone calls

– 14 non-working numbers

– 227 appointments (17 still upcoming)

– 136 vaccines given

– 40 no-shows (no-show rate: 19%)

– 27 showed for appointment but did not receive vaccine (13%)

– Total number of patients reached by any of the above: 523

– Start of project: ~523/3154 patients ages 11-21 overdue for dose 2 or 3 of HPV (16%)

– Currently: ~387/3154 overdue (12%)

Closing• We have expanded to all pediatric patients.

• We decreased the percentage of patients ages 11-16 overdue for doses 2 or 3 from 16% to 12%.

Next Steps:• Next step: expand to patients seen in Family and Adult medicine

• Integrating outreach into existing staff workflows (sustainability)

• More patient education/proactive reminders to avoid overdue patients

• Any questions?

Tapestry HealthHPV Awareness Project

Successes• Identified and worked with stakeholders: Massachusetts Department

of Public Health, LGBT Youth Programs, High Schools and colleges

• Scheduled and provided information to targeted populations at nine outreach and education events to 182 individuals including four “formal” educational sessions

• Developed informational awareness materials and advertising

• Twenty-one individuals received vaccination during the project to date. All have followed up with series.

Challenges1. Coordinating insurance eligibility for vaccination

2. Coordinating messaging between departments

3. Mobile unit not as popular as anticipated

Lessons Learned/Best Practice

• Groups were better at resulting in engagement in vaccination

• Other benefits of vaccination such as possible less pap/colposcopy, potential genital wart prevention vs cancer prevention was useful engagement tool

• Engagement of men was beneficial for engaging both men and women

Evaluation/Measurable Outcome• 182 individuals from target population engaged in awareness

• 21 individuals vaccinated (13 girls, 8 boys)

• 11 Health providers engaged

• 11 parents engaged in focus group – Conversations about sex and sexual health – Concerns about side effects – Autism – Availability and where to get it – Information on “series” – Other prevention methods – Genital Warts – Why age limit?

ClosingNext Steps• Follow up continues

– Men’s Group follow up clinic & focus group invites

• Workshop with providers • Outreach events in collaboration with

Baystate Health

Questions?

Jefferson County Public Health Service

Successes• Marketing Reach- Bus ads, online presence, social media, food

pantries, churches, providers, JCPHS clinic, JCPHS home health care, events, press releases, news stories, public libraries, government offices, human service organizations, and direct education at GED orientation classes.

• “A Toolkit For Clergy To Improve the Health Of The Congregation And The Community Through Vaccinations”

• Adult Vaccine Self Assessment Tool

• Provider Training E-Newsletter

Challenges• Short time frame – Needed to assess local problem more in

depth to develop a local response.

• Evaluation of impact difficult in time frame.

• Provider funding for vaccines and/or vaccine supplies (freezers).

• Getting materials to outlying areas of county. Enlisted home health staff and North Country Library System assistance to overcome challenge.

Lessons Learned/Best Practices• Utilized lessons learned from other past evidenced based

JCPHS social marketing campaign (Could It Be Asthma?) and applied to this project to save time.

• Develop or update list of contacts well in advance of due dates.

• Use resources/groups (even non-traditional ones) that are already available. Using a Fall Prevention class, for example was already a ‘gathering place’ to get message out.

Evaluation/Measurable Outcomes520 Providers –With direct education in class setting, through training e-newsletter, or through an event. (*some providers may have been reached more than once but with different messaging)• 34 Religious Organizations

• 18 Food Pantries

• 422 Library Patrons who use direct mailing

• 12,318 monthly bus ridership

• 4,076,554 Impressions on Newzjunky.com

• 75,000+ Media Reach

• 50,000+ reached at events

Vaccinations: Unable to determine cause/effect• JCPHS Clinic-Slight increase in vaccinations given –less than 1%

• Home Health-June 91.1% had Pneumococcal vaccine-implemented tool in July by end of July 92.7% had Pneumococcal vaccine

Closing• The Assessment Screening Tool will continue to be

refined and reworked based on ACIP and end user suggestions.

• Resources are available at http://www.jcphs.org

• Questions?

Monroe County Department of Public Health

The Impact of Community Partnerships and Public Health Outreach on Immunization Rates for the Elderly

Successes• Partnerships fostered with 2 large adult housing

providers

• Baseline and post-intervention color-coded surveys administered to residents in both English and Spanish

• Outreach educational materials developed and distributed

• Educational sessions provided by PHNs

Challenges

• Barriers to identifying target population within housing sites

• Language barrier

• Turnover within organizations

• Partner participation

Lessons Learned/Best Practice

• For partnerships: MOU

• For target population:– Advertise– Positive reinforcement

• For implementation:– Color code– Sufficient clerical support

Evaluation/Measurable Outcomes• Demographic picture

• Obstacles to care, risk factors, immunization status

• Percent of previously unvaccinated participants who received either of the targeted immunizations following an intervention

• Cost-benefit analysis of interventions

• Impact of Service Coordination

Closing

• Next Steps…Data analysis

• Questions?

Question and Answer Session

Please send questions via WebEx chat box.

Please visit http://nvpo.jbsinternational.com to view Webinar recordings and presentations

Next Webinar: August 26, 2013, 2:00 p.m. (ET)