Adult Immunization Assessment Challenges in Georgia

1
Adult Immunization Assessment Challenges in
Georgia

• Achal Bhatt, PhD and Ben Sloat, MPH
• May 13th, 2004
• National Immunization Conference

2
Outline

• Background
• Objective
• Findings
• Results
• Challenges
• Next Steps

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Influenza Vaccination Coverage Levels in Georgia
and Goals for Persons Aged 65
Source BRFSS, 2002
4
Pneumococcal Vaccination Coverage Levels in
Georgia and Goals for Persons Aged 65
Source BRFSS, 2002
5
Georgia Location for Obtaining Influenza Shot by
Age
of Respondents
Source BRFSS, 2002
6
Adult Clinic Assessment Software Application
(ACASA) I

• Tool for assessing immunization practices
• within a clinic, private practice or any other
  provider site.
• Available to download for free at
  www.cdc.gov/nip/casa/acasa/acasa.htm
• Can assess vaccination levels of adults
• Can create variety of customized reports to help
  clinical staff diagnose service delivery problems
  and improve the quality of care

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Adult Clinic Assessment Software Application
(ACASA) II

• Can analyze missed opportunities for influenza
  vaccination
• Can collect reasons not vaccinated
• Can collect individualized chart notes and
  user-defined fill-in the blank and Y/N questions
• Can be customized to look at different age
  groups, high risk conditions and antigens

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Project Objective (I)

• To determine feasibility of
• Identifying/recruiting adult immunization
  providers for practice-based assessments
• Assessing individual clinics adult vaccination
  levels using ACASA
• Educating providers on strategies to improve
  their adult immunization practices

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Project Objective (II)

• To identify challenges faced by
• State health department staff
• Adult immunization providers and staff

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Identification of Providers for Practice-Based
Assessments

• Identifying current Vaccines For Children
  providers who also serve adults
• Partners
• Educating Physicians in their Communities (EPIC)
• Georgia Adult Immunization Coalition
• Georgia Medical Care Foundation (GMCF)
• Epidemiology Branch at Georgia DHR

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Recruitment of 7 Participating Family Physicians

• 4 identified through VFC consultants
• 3 identified through EPIC program database
• Flyer response rate 2.6 (3/115)
• No physicians identified through
• Georgia Adult Immunization Coalition
• GMCF
• Epidemiology Branch at Georgia DHR

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Methods to Assess Individual Clinics Adult
Vaccination Levels Using ACASA

• 30 randomly selected records per clinic
• Influenza, pneumococcal and tetanus coverage
• Patients 65 and older by last flu season
• Active patient (seen within last year)
• Seen by the clinic for 1 year

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Results Using ACASA

• Vaccination levels for Influenza and pneumococcal
  lower than BRFSS
• 1.2 missed opportunities for influenza per
  patient

14
Vaccination Coverage Levels for Patients 65 and
Over in Private Provider Offices
Influenza
Pneumo
Source BRFSS, 2002
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Lessons from Record Assessment

• Average time for record assessment
• 8.15 minutes per record
• Varied 2 minutes to 20 minutes
• 4 ½ hours needed per 30 assessments
• Lack of documentation
• Reason not vaccinated
• Demographic data
• Race recorded
• Ethnicity not recorded
• Health Insurance status recorded

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Feedback to Provider Staff

• ACASA results provided same day
• Practices eager for results
• Feedback session duration varied from 15 min to 1
  hour
• Conversations about other immunization topics

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Results of Staff Survey Evaluating Feedback
Sessions

• Education materials helpful
• Vaccine administration record forms
• Adult immunization schedules
• Adult standards
• Requests for additional materials
• Interest in Adult EPIC training
• Plan to take action over the next 6 months

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Challenges Adult Immunization Providers

• Changing practice staff behavior
• Using specific immunization record forms
• Distribution of educational materials
• Changing patient behavior
• Increasing patient knowledge
• Getting patient to come in for immunizations
• Addressing patient misconceptions

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Challenges Health Department Staff

• Identifying physicians who serve older adults
• Technical issues with ACASA
• Problems with data fields
• Data cannot be downloaded as with childhood CASA
• HIPAA compliance
• Addressing misconceptions

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Next Steps

• Continue conducting assessments
• Follow-up with the providers next year
• Expanding through partnerships
• Medicare
• Adult EPIC
• GMCF
• Physician organizations-AMA, internists

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Conclusions

• Assessing adult immunization using ACASA is a
  feasible approach in GA
• Assessments provide opportunity to educate office
  staff on strategies that can improve a clinics
  immunization practices

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Acknowledgement

• Georgia Immunization Program
• Mike Chaney
• Ben Sloat
• Marie Hicks
• EPIC
• Melonie Jackson
• Adult Immunization Coalition
• Georgia Medical Care Foundation

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Questions?

• Contact Ben Sloat
• Phone [phone]
• Email Wbsloat_at_dhr.state.ga.us