Bob Swanson, MPH Michigan Department of Community Health Adult Immunization Program and Initiatives

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1 Bob Swanson, MPH Michigan Department of Community Health Adult Immunization Program and Initiatives Michigan Primary Care Consortium s Adult Immunization Second Plenary Session March 29, 2012

2 MDCH Adult Immunization Program: Outline Childhood and adolescent accomplishments MDCH programs, resources, and tools Role of LHDs Partnerships AIM, MACI, FAB, ACOG Coverage levels Educational resources, projects, and websites Future directions and efforts

3 Childhood and Adolescent Immunization Accomplishments

4 Percent Immunized National Immunization Survey Data for Michigan :3:1 4:3:1:3 4:3:1:3:3 4:3:1:3:3:1 4:3:1:3:3:1:4 4:3:1:-:3:1:4 Year

5 Vaccines for Children Program (VFC) Child entitlement program for vaccines Medicaid Uninsured Native American/Alaskan Native Under-insured seen in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) Delegation of Authority in Michigan allows LHDs to vaccinate on behalf of FQHCs LHDs and FQHCs have agreements in place

6 Vaccines for Children Program (VFC) Nationally - nearly $4 billion program Michigan receives around $110 million in vaccine annually 1,450 enrolled VFC providers in Michigan Nearly 1,200 VFC site visits done annually to provider offices Primarily pediatrics (248 providers) and family practice (857 providers)

7 Michigan Care Improvement Registry (MCIR) Established in Michigan Childhood Immunization Registry Expanded to adults in Michigan Care Improvement Registry 7.4 million individual records in MCIR 90 million shot records in MCIR 1,248 active family practice providers 498 active pediatric providers Repository for doses of vaccine and accessible by health care providers

8 Features of MCIR Assessment and forecasting of needed vaccine doses Population/clinic-based coverage levels Reminder/recall functionality Vaccine inventory control/accountability Manage public health outbreaks and preparedness responses

9

10 Educational Programs Immunization Nurse Education (INE) Modules (9) Physician Peer Education (PPEPI) Modules (6) Regional Immunization Conferences (8) Attended by nearly 1,800 health care providers annually Newsletters Distributed to nearly 8,000 people Websites

11 Provider Performance Feedback (AFIX) Strong evidence of effectiveness in improving vaccination coverage: In adults and children When used alone or with additional components Involves: Evaluating provider performance in vaccinating a particular client population Giving feedback on performance (may include incentives and benchmarking) 1,000 feedback sessions with VFC providers Source: The Community Guide,

12 School Reporting: Communicable Disease Requirements Since 1978, report all new entrants to a school district 2002 added in 6 th grade reporting requirement DTaP, polio, MMR, Hepatitis B, varicella Tdap and meningococcal vaccines starting at 11 years of age Preparation for adulthood

13 Vaccinate Adolescents to Protect Adults Protected Adolescent Annual flu DTaP/Tdap MCV4 HPV Hep B Hep A Varicella Pneumoccoccal MMR Hib Polio Rotavirus Average Healthy Adult Annual flu Tdap every 10 years Pneumoccoccal Zoster

14 Michigan s Adult Immunization Platform

15 Adult Program Objectives Federal Recommended Objectives: Work with partners to promote the adoption of evidence-based approaches to increasing adult vaccination Work with partners to increase influenza vaccination of health care workers As 317 funds permit, increase access to vaccines for high risk adults MI Objective: Promote the establishment of an adult vaccination platform with immunization partners

16 Michigan s 317 vaccine funding 317 vaccine primarily used to vaccinate underinsured children in private provider offices All ACIP recommended vaccines included for children and adolescents Less than $1 million of 317 vaccine used for targeted adults

17 Michigan Vaccine Replacement Program (MI-VRP) Public vaccines (purchased by MDCH) administered through Local Health Departments Federally Qualified Health Centers (FQHCs) Tribal Health Centers Community Health Centers Migrant Health Centers Local Health Department (LHD) clinics Very specific eligibility criteria (unlike VFC, race/ethnicity is not a criteria)

18 MI-VRP Criteria Patients must qualify in all four areas: Age Must be 19 years of age or older Lack of insurance Uninsured or under-insured Need for specific vaccines Vaccines offered: Tdap, Td, MMR, Hep A, Hep B Specific risk factors Varies by vaccine

19 Michigan Care Improvement Registry (MCIR) Over 4 million adult immunization records in MCIR 13% increase in 2011 Over 24 million individual adult shot records in MCIR 20% increase in 2011 Reporting is highly encouraged; best practice for immunization MCIR Data current as of December 31, 2011

20 Role of Local Health Departments in Increasing Adult Immunization Rates

21 Role of LHDs Immunization Coordinators facilitate the MI-VRP program LHDs often carry out special, one-time funding programs such as ARRA Serve as point of reference for immunization providers on immunization issues pertaining to MCIR, MI-VRP, ARRA

22 Michigan Local Health Departments

23 Partners LHDs Collaborate with on Adult Immunizations IAP Report, Fall 2011

24 Adult Immunization Partnerships

25 Alliance for Immunization in Michigan (AIM) Coalition Formed in 1994 in response to low childhood immunization coverage levels Annual AIM Provider Toolkit printed since 1996 Around 4,000 kits printed each year Coalition at-large meets quarterly; subcommittees meet on regular basis Adult immunization workgroup in existence

26 Mission of AIM To promote immunizations across the lifespan through a coalition of health care professionals and agencies. Representation from state health dept., local health depts., hospitals, health systems, health plans and insurance providers, private provider offices, visiting nurse associations, community vaccinators, and pharmaceutical industry

27

28 Michigan Advisory Committee on Immunizations (MACI) Advise MDCH on immunization programs and policies, including communicable disease rules Representation from hospitals, health systems, nursing associations, OBGYNs, pediatricians, family practitioners, occupational health, infection control, college health, Medicaid, local public health, and more Quarterly face-to-face meetings

29 Flu Advisory Board (FAB) Comprised of over 160 members representing public and private health Formed in 2005 as an Extension of MACI Member organizations from nurse associations, health systems, pharmacies, community vaccinators, health plans, private medical practice, health advocacy groups, and local public health Quarterly face-to-face meetings

30 ACOG Project: Increasing Immunization Practices among OBGYNs 4 states: Indiana, Kentucky, Ohio, Michigan 3 kick-off sessions Peer-to-peer training featuring OBGYN champion In office follow-up through INE program Vaccinating Women Across the Lifespan, VFC, MCIR, Storage and Handling Key Findings: OBGYN practices added new vaccines Immunizations becoming more routine in OBGYN practices

31 Adult Immunization Coverage Levels

32 Adult Immunization Educational Resources, Projects, and Websites

33 MDCH Immunization Webpage

34 Pertussis Letters from MDCH Chief Medical Executive Birthing Hospitals OBGYNs Hospital CEOs Pertussis webpage at:

35 Michigan Immunization Timely Tips (MITT) Newsletter

36 Helping Adult Clients Pay for Vaccines

37 Tdap & Flu Pregnancy Materials

38 Adult Posters

39 Future Directions & Efforts

40 Doctor-Patient Communication Breakdown 90% physicians say they discuss vaccines with patients Half of consumers cannot recall ever discussing vaccines with provider 99% physicians say they or their staff initiate vaccine conversations 44% of patients agree National Health Interview Survey, 2009

41 Moving Forward Providers who care for adults need to be involved with immunizations Recommend to patients Purchase and stock vaccines Be knowledgeable about the current schedule The public needs to be knowledgeable about vaccines Lack of awareness about vaccines needed VPDs are no longer a perceived threat

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