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Aging

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Title: Aging


1
Aging Immunization Webinar
  • Wednesday, August 31, 2005
  • Presented by
  • Administration on Aging
  • Centers for Disease Control and Prevention
  • Centers for Medicare and Medicaid Services
  • National Association for State Units on Aging

2
  • Agenda
  • Welcome and Opening
  • Diana Lawry, Aging Program Specialist, Center
    for Planning and Policy Development, AoA
  • Introduction to Influenza Pneumococcal
    Vaccinations for Older Adults
  • Tamara Kicera, Senior Public Health Advisor,
    National Immunization Program, CDC
  • Profiles of Successful State Local Immunization
    Strategies
  • Action for Community Enrichment (ACE) Coalition
  • Anne Bailowitz, Bureau Chief, Bureau of Child
    Health and Immunization, Baltimore City
    Health Department
  • Immunize North Carolina
  • Mary Bethel, Manager, Consumer Affairs, North
    Carolina Division of Aging
    Adult Services
  • North Texas Adult Immunization Coalition
  • Paul Zobisch, Chair, North Texas Adult
    Immunization Coalition

3
  • Agenda
  • Resources
  • Immunization Best Practices
  • Catherine Gordon, Senior Public Health Analyst,
    Office of the Director, CDC
  • Web Resources
  • Jacqueline Harley, Co-Government Task Leader,
    Office of Clinical Standards and Quality, CMS
  • Questions and Answers

4
Influenza Pneumococcal Vaccinations for Older
Adults
Tamara J. Kicera Immunization Services
Division National Immunization Program Coordinatin
g Center for Infectious Diseases Centers for
Disease Control and Prevention
5
Vaccine-Preventable Diseases in Adults
  • Approximately 40,000 deaths, 200,000
    hospitalizations annually in the US
  • Most in persons gt65 years of age Minorities
    affected disproportionately
  • Vaccines are cost-effective, but under-utilized
  • Influenza and Pneumococcal Polysaccharide
    vaccines which address the greatest burden of
    adult VPDs are covered Medicare Part B benefits

6
Recommended Adult Vaccines
  • Influenza
  • Pneumococcal (PPV)
  • Hepatitis B
  • Hepatitis A
  • Tetanus-diphtheria
  • Measles-Mumps-Rubella
  • Varicella (Chickenpox)
  • Meningococcal

7
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8
Influenza
  • Highly infectious viral illness
  • Annual/seasonal epidemics reported since at least
    1510
  • Major pandemics have occurred (1918-19, 1957-58,
    1968-69)
  • 1918-19 pandemic killed an estimated 21 million
    worldwide

9
Influenza Not just a bad cold!
  • Virus spreads from infected persons to the nose
    or throat of others
  • Lasts several days and causes fever, sore
    throat, chills, fatigue, cough, headache, muscle
    aches
  • Can lead to pneumonia and be much more serious in
    older adults

10
Influenza Vaccine (annually)
  • Persons 50 yrs and over
  • Persons 6 mo-49 yrs with certain medical
    conditions
  • Persons in LTC facilities
  • Household contacts of persons at high risk of
    complications
  • Healthcare workers of any age

11
Pneumococcal Disease
  • Can lead to serious infections of the lungs
    (pneumonia), the blood (bacteremia), and the
    covering of the brain (meningitis)
  • Fatal for 1/20 with pneumonia 2/10 with
    bacteremia and 3/10 with meningitis
  • Older adults are among groups more likely to die

12
Pneumococcal Vaccine
  • Once for persons 65 yrs and older
  • Persons 2-64 yrs with certain medical conditions
  • Residents of LTC facilities
  • Infections have become antibiotic resistant, so
    treatment is more difficult prevention is more
    critical

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15
Increasing Adult Vaccination Rates What Works?
  • Patient/Provider Reminder/Recall
  • Multicomponent interventions plus education
  • Reducing out-of-pocket costs
  • Expanding access plus multicomponent
    interventions
  • Provider assessment feedback
  • Standing Orders

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17
Useful Resources
Influenza and Pneumococcal Vaccination Coverage
Among Persons Aged gt65 Years and Persons Aged
18-64 Years with Diabetes or Asthma US, 2003,
MMWR, November 5, 2004 / 53(43)1007-1012 www.cdc.
gov/mmwr/preview/mmwrhtml/mm5343a2.htm   Influenza
Vaccination and Self-Reported Reasons for Not
Receiving Influenza Vaccination Among Medicare
Beneficiaries Aged gt65 years US, 1991-2002,
MMWR, November 5, 2004 / 53(43)1012-1015  www.cdc
.gov/mmwr/preview/mmwrhtml/mm5343a3.htm   CDC/Nati
onal Immunization Program www.cdc.gov/nip   CDC/Na
tional Immunization Program/Racial and Ethnic
Adult Disparities in Immunization Initiative
(READII) www.cdc.gov/nip/specint/readii/
18
More resources
  • Partnership for Prevention Strengthening Adult
    Immunization A Call to Action www.prevent.org/pub
    lications/CalltoAction.pdf
  •  
  • DHHS/Office of Minority Health www.omhrc.gov
  •  
  • NIH National Center on Minority Health and Health
    Disparities www.ncmhd.nih.gov
  •  
  • AHRQ 2004 National Heath Care Disparities
    Report www.qualitytools.ahrq.gov/disparitiesreport
    /browse/browse.aspx
  •  
  • Institute of Medicine Unequal Treatment
    Confronting Racial and Ethnic Disparities in
    Health Care, March 2002 www.iom.edu/report.asp?id
    4475
  •  

19
Action for Community Enrichment Coalition (ACE)
An Approach to Influenza and Pneumonia
Immunization
  • Anne Bailowitz, MD, MPH
  • Baltimore City Health Department
  • August 31, 2005

20
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21
Action for Community Enrichment
Background - 1
  • Action for Community Enrichment (ACE)
  • Immunization Action Coalition
  • Roots in Good Neighbor Flu Project
  • (GNFP) 1995/6
  • Purpose Build Partnerships with
  • Public Health Neighbors by
  • using HCFA (CMS) data, experience
  • resources
  • To develop Strategies to improve
  • Utilization of Medicare
    Preventive
  • Services

22
Background - 2
  • Influenza and pneumonia immunization
  • Inner city focus (Baltimore) African American
    Hispanic American, Asian American, Native
    American
  • Seniors gt 65 years initially 50 years 6-23
    months
  • Funding Federal GNFP startup
  • Funding Roster billing provides ongoing funds

23
Planning - 1
  • Start organizing asap after prior season e.g.
  • January - March
  • Debrief re successes and failures of past season
  • Select possible sites and have a committee member
    contact each - emphasize vaccine supply issues
  • Initial monthly meetings, then more often

24
Planning - 2
  • Order vaccines asap March and follow-up
  • Have back-up plans if vaccine arrives later or
    less
  • Baltimore experience 2004-5
  • Start early (October), stay late (February
    April)
  • 20-25 clinics 50 1,000 clients geography
  • Follow CDC guidelines plus local edits

25
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26
Implementation - 1
  • Be flexible but VERY organized
  • Establish a good working relationship with sites
    let them lead (as much as possible)
  • Have adequate trained staff feed them
  • Get clients inside asap
  • Patient flow graphics 30 minutes/client
  • Give numbers to clients upon entry

27
Implementation - 2
  • Transportation is not currently provided
  • All sites are handicapped accessible
  • Link homebound clients with home nurse visitors
  • Health / Aging collaboration project to provide
    pneumonia immunization to Meals on Wheels clients

28
Outcomes - 1
  • 1997 2004 Steady increase in number ACE
    immunized
  • Pre ACE (1995) 11 City immunized
  • With ACE (1997) 19 immunized
  • 2004-5 Best season 5,340 immunized
  • Since inception 34,500 Baltimore citizens
  • immunized

29
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30
Outcomes - 2
  • Hammer Award for Reinventing Government 2000
  • Maryland Immunization Excellence Award - 2004

31
Partnerships -1
  • Dual leadership Baltimore City Health Department
    and University of Maryland Medical System
  • Critical role of enduring (9 years ) and
    expanding partnerships
  • Key partners

32
Partnerships - 2
  • Churches
  • Black Nurses Association of Baltimore
  • Chi Eta Sorority
  • Senior Centers
  • Commission on Aging and Retirement Education
    (CARE) Pneumovax Project
  • Malls Celebrating Seniors

33
Partnerships - 3
  • Bon Secours / Urban Medical Institute
  • Delmarva Foundation for Medical Care
  • Schools of Nursing University of Maryland,
    Johns Hopkins
  • Elder Health
  • Maryland Department of Health and Mental Hyiene
  • Maryland Partnership for Prevention
  • Centers for Medicare and Medicaid Services

34
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37
Lessons Learned - 1
  • Coalition must include target groups
  • - Act as a focus group
  • Dual leadership is a strength
  • Flexibility is key
  • Plan ahead start asap after your season
  • ends debrief
  • Recognize contributions

38
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39
Lessons Learned - 2
  • Sustainability get members who have a stake in
    the outcome
  • - Target groups (assist in marketing)
  • - Agencies Health, Aging, etc.
  • Marketing media exposure can be expensive
  • - PSAs, local church bulletins, local papers
  • - National videos Standing in the Safety Zone
  • (99, 02) Roster Billing (03)
  • - Pneumococcal Awareness Days, Peer-to-Peer
  • Pneumococcal Physician Education

40
Lessons Learned - 3
  • Homebound services
  • Minimize paperwork
  • Vaccine production and distribution issues

41
Summary
  • Partnerships are essential - must be nurtured and
    expanded
  • Planning starts early
  • Flexibility and diplomacy are basic tools
  • We need help with vaccine development, supply
    and funding

42
For More Information Contact
  • Anne Bailowitz, MD, MPH
  • Chief, Bureau of Child Health Immunization
  • Baltimore City Health Department
  • (e) Anne.Bailowitz_at_baltimorecity.gov
  • (c) 410.236.9285
  • (f) 410.396.3965

43
Immunize North Carolina
  • Mary Bethel, Manager, Consumer Affairs North
    Carolina Division of Aging
  • Adult Services
  • 919-733-3983 mary.bethel_at_ncmail.net
  • (PowerPoint not available)

44
North Texas Adult Immunization Coalition
  • MISSION
  • The North Texas Adult Immunization
  • Coalition promotes adult immunizations
  • through community outreach,
  • education and partnerships.

45
Objectives
  • Performing community outreach in traditional and
  • non-traditional settings.
  • Providing adult immunization education to the
    general public and health organizations.
  • Facilitating partnerships with public and private
    entities.

46
The Beginning
  • Started as the Good Neighbor program in the
    mid 1990s focusing on the importance of Adult
    Immunizations specifically Flu and Pneumonia.

47
Members Partners
  • A group of community partners was assembled,
    resources combined with a small army of motivated
    agencies and volunteers set out to educate the
    community on the importance of immunizations.

48
  • AARP
  • Baylor Health Care Systems / Senior Health
  • Centers for Medicare and Medicaid Services
  • Community Council of Greater Dallas
  • Dallas Area Agency on Aging
  • Dallas Dept. of Envir. and Health Services
  • City of Fort Worth Public Health
  • Dallas County Health and Human Services
  • Dallas County Medical Society
  • Garland Health Department
  • Maxim Healthcare Services
  • Merck Vaccine Division
  • Methodist Hospital of Dallas
  • North Central Texas Area Agency on Aging
  • Sanofi Pasteur, Inc
  • The Senior Source
  • The Senior News Source
  • Tarrant County Area Agency on Aging
  • Tarrant County Public Health Department
  • Texas Department of State Health Services
  • Texas Medical Foundation
  • TrailBlazer Health Enterprises, LLC
  • Visiting Nurse Association
  • Wyeth Pharmaceuticals

49
Work Groups
  • Community Education
  • Develops strategies for disseminating
    information about public health benefits and
    adult immunizations.
  • Media
  • Leads NTAICs awareness efforts serving as
    liaison to the media, the broader community.
  • Membership
  • Coordinates reviews and approves all
    application for membership, recruits new members,
    and implements new member trainings.

50
Work Groups 2
  • Provider Education
  • Develops strategies for educating providers
    regarding the importance of administering adult
    immunizations, and the laws and guidelines
    regarding serving Medicare recipients.
  • Events Workgroup
  • Plans and implements approved events and
    programs.

51
Education
  • Education is wide spread throughout the
    North Texas area with general information in the
    form of flyers that are distributed at Senior
    Centers, libraries and at Community Health Fairs.
    Special attention is paid to underserved areas as
    identified by CMC, CDC and Health Departments.

52
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53
Community Health Fair Added
  • In 2003 it was decided to expand the
    education effort to a centrally located Community
    Health Fair and Free Flu Shot event. The annual
    event is called the North Texas Shoot Out and
    branded with our mascot Fluie Louie.

54
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55
Critical Components
  • North Texas is very large and diverse. The Dallas
    / Fort Worth Metroplex encompasses many counties.
    So a central location was and is imperative.
  • Another critical part was the Free. CMS had given
    the original coalition some start up funding
    which was used in securing a location and to
    cover many of the cost.
  • Bringing in the right mix from the private sector
    for additional funding was critical.

56
Getting Funding
  • Sponsorships and exhibit tables were sold to
    raise funds. The 2004 event had more than 70
    exhibitors from both the non-profit and private
    sector (all non-profit agencies were given Free
    exhibit space).

57
Media
  • Getting media attention is crucial and very
    difficult. News releases are sent to all TV,
    Radio and Newspapers as well as newspaper ads are
    purchased in both of the daily newspapers as well
    as Suburban Community Papers publicizing the
    event. Delivery of t-shirts with the saying Get
    the Shot, Not the Flu are hand delivered to key
    news personnel.

58
Press Conference
  • A press conference is also scheduled early in
    the morning of the event to attract TV and Radio
    news coverage. Local elected officials as well as
    CMS officials are invited to speak at the press
    conference on the importance of getting a flu
    shot.

59
  • The North Texas Adult Immunization Coalition
    promotes
  • adult immunizations through community outreach,
    education and partnerships.
  • October 20, 2003
  • ADVISORY PHOTO OPPORTUNITY
  • DALLAS TARRANT COUNTY SHOOT OUT EVENT
  • OFFERS FREE FLU SHOTS TO SENIORS
  • The North Texas Adult Immunization
    Coalition (NTAIC) will sponsor a North Texas
    Shoot Out event providing free flu shots to
    high-risk senior citizens. Tarrant and Dallas
    Counties will compete to immunize the most
    seniors. Elected officials and health
    authorities will represent their county by being
    vaccinated. The event will feature a health fair
    and Country Western entertainment provided by
    the Mesquite Opry.
  • Each year in the U.S., complications
    from the flu result in more than 36,000 deaths
    and 114,000 hospitaliza-tions. In 2001, 496
    Texans in Dallas and Tarrant Counties died from
    influenza. The NTAIC represents more than 40
    agencies from 11 North Texas Counties that strive
    to increase immunization rates among high-risk
    individuals.
  • What Dallas Tarrant County Elected
    and Health Officials Get Their Flu Shot at press
    event
  • Who Michael Burgess, M.D., U.S.
    Congressman
  • Martin Frost, U.S.
    Congressman
  • William Zedler, Texas
    Representative
  • Lou Brewer, Tarrant County
    Public Health Director
  • Robert Cluck, M.D., Mayor of
    Arlington
  • James Randolph Farris, M.D.,
    Centers for Medicare and Medicaid Services
  • Other dignitaries are invited
    but are not yet confirmed!

60
Success
  • The success of N.T.A.I.C. can be attributed
    to the commitment and hard work of all coalition
    members.

61
Salt Lake County Aging ServicesShauna ONeil,
Director
  • Flu Vaccination
  • a part of the
  • Healthy Aging Program

62
Health Aging Program
  • Founded ca. 1974
  • Target audience age 60 plus
  • Three components
  • Wellness education
  • A focus on substance abuse education
  • English as a second language
  • Health Screening Services preventative clinics

63
Health Screening
  • Staff one 30 hour nurse administrator
  • 300 Volunteer Health Professionals
  • Practicing professionals
  • Retired nurses
  • Faculty instructors
  • Students pharmacy and nursing

64
Flu Vaccination
  • Initiated early 1980s
  • 10,000 flu vaccines annually
  • Pneumococcal tracking problems
  • Grew out of
  • Health Fairs
  • Requests from customers
  • Primary health care unavailable
  • Doctors visits expensive
  • Alternative providers unavailable
  • Help local health department respond to requests

65
Funding
  • Older Americans Act
  • County General Fund
  • Donations
  • Medicare

66
The Program
  • Senior Expo Trade Fair
  • October flu shot kick off
  • Mailing to 100,000
  • 2 annual drive by shootings
  • Large parking lot
  • Homebound elderly - not home health clients
  • Senior Centers
  • Senior housing skilled nursing facilities
  • Ethnic gatherings

67
Partnerships
  • Schools four nursing programs
  • Aging Services - the local area agency
  • Senior Centers
  • Meals on Wheels
  • In-home Services
  • Housing providers
  • State immunization coalition
  • Hospitals, home health agencies

68
Lessons Learned
  • A variety of sites is important serve the
    customer where you find them
  • Be sensitive to frail clients who cant wait
    their turn in line
  • Volunteers efficiency machines
  • Reception
  • Registration
  • Crowd control
  • Dont compete with private vendors
  • Contingency plans for vaccine shortage

69
Lessons Learned, cont.
  • Public information is key to a successful event
  • TV the night before
  • Radio that morning
  • Posters/fliers/newspapers in multiple languages
  • Anticipate lessen blockages caused by paperwork
  • Early registration
  • Registration away from the nursing staff

70
For further information
  • Shauna ONeil, Director
  • Salt Lake County Aging Services
  • 801-468-27610
  • Dee Dee Lobato, Manager
  • Healthy Aging Program
  • 801-468-2473

71
More Best Practice Programs
  • Catherine Gordon
  • Senior Public Health Analyst
  • Office of the Director
  • CDC

72
Innovative Approaches
  • Promote immunizations through
  • (From New York)
  • Case management
  • State health insurance counseling programs
  • Caregiver resource centers
  • Websites that provide immunization
  • locations

73
Innovative Approaches
  • Promote immunizations through
  • (From Chicago)
  • - Trusted messengers (e.g., Alderman Offices)
  • (From Other Sites)
  • - Existing health programs at faith-based orgs
    (MI)
  • - Home delivered meals programs (AZ)
  • - Local public access TV channel (ID)

74
Lessons Learned
  • Partnerships with key players are valuable
  • - especially State Health Departments
  • - identify other key players in your
  • community
  • - flexibility and teamwork are important
  • Weave immunization into a broader approach to
    senior wellness

75
Lessons Learned
  • Know/understand where seniors receive services in
    your community
  • Some aging service providers may feel more
    comfortable conveying health information when
    training is provided

76
ResourcesInfluenza and Pneumococcal Vaccinations
  • Jacqueline Harley
  • Office of Clinical Standards and Quality
  • Centers for Medicare Medicaid Services

77
  • Centers for Medicare Medicaid Services
  • Medicare Preventive Services (Influenza/
    Pneumococcal Campaign/Adult Immunization)
  • This website provides information and resources
    related to the coverage, billing, delivery, and
    promotion of influenza, pneumococcal, and
    hepatitis B vaccinations, includes CDCs READII
    project, etc.
  • www.cms.hhs.gov/preventiveservices/2.asp

78
  • CMS Immunization Educational Resource Web
    Guide
  • This Educational Resource Guide at
    www.cms.hhs.gov/medlearn/refimmu.asp contains
    educational information such as Medlearn Matters
    Articles, print materials, and other resources,
    related to Adult Immunizations, including
    influenza vaccine, pneumococcal polysaccharide
    vaccine and Hepatitis B virus

79
  • Center for Disease Control and Prevention
  • Influenza and Pneumococcal Vaccination Coverage
    Among Persons Aged gt65 Years and Persons Aged
    18-64 Years with Diabetes or Asthma US, 2003,
    MMWR, November 5, 2004 /53(43)1007-1012
  • www.cdc.gov/mmwr/preview/mmwrhtml/mm5343a2.htm
  • Influenza Vaccination and Self-Reported Reasons
    for Not Receiving Influenza Vaccination Among
    Medicare Beneficiaries Aged gt65 years US,
    1991-2002, MMWR, November 5, 2004 /
    53(43)1012-1015 
  • www.cdc.gov/mmwr/preview/mmwrhtml/mm5343a3.htm

80
  •  CDC/National Immunization Program
  • This website contains information about vaccine
    preventive diseases, the benefits of
    immunization, and the risks of immunization
    versus the risk of disease, as well as
    educational materials and resources.
    www.cdc.gov/nip
  •  

81
  • Administration on Aging
  • This website contains information about vaccine
    related immunizations (influenza and
    pneumococcal) and other resources on vaccinations
    for adults
  • Professionals - Immunization www.aoa.gov/healthy_
    lifestyles/phl.asp
  • Elders and Families Immunization
  • www//aoa.gov/eldfam/Healthy_Lifestyles/Vaccine/va
    ccine.asp

82
  • Additional Immunization Resources
  • Agency for Healthcare Research Quality (AHRQ)
    2004 National Heath Care Disparities Report
    www.qualitytools.ahrq.gov/disparitiesreport/browse
    /browse.aspx
  • Immunization Action Coalition Adults Only
    Vaccination A Step by Step Guide 
    www.immunize.org/guide/index.htm

83
Additional Immunization Resources
  • National Institute of Health (NIH) National
    Center on Minority Health and Health Disparities
  • www.ncmhd.nih.gov
  • Immunization Action Coalition Adults Only
    Vaccination A Step by Step Guide
    www.immunize.org/guide/index.htm

84
  • THANK YOU!!!
  • Jacqueline Harley
  • 410-786-7222
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