During a June 13 panel discussion at the AAFP Adolescent Immunization Office Champions Project Conference here, Marlon Weiss, M.D., of Family Practice Specialists LLC in Lincoln, Neb., said that participating in the project has motivated him to actively engage his community in promoting immunizations.
Janice Baker, M.D., of Chatham Family Practice in Chatham, N.J., tells attendees at the AAFP Adolescent Immunization Office Champions Project Conference she has seen a vast improvement from a couple of years ago in parents' acceptance of the HPV vaccine for their adolescent children.
"Up until now, I have been experimenting," he said. "This (project) will give me the select tools to help improve (immunization rates) in my community."
Amrish Patel, M.D., of Troutman Family Medicine in Troutman, N.C., agreed with Weiss' comments, saying, "I think community outreach makes a big impact by stating the positive, because there is so much negative out there (about immunizations) that drowns out the positive. If more physicians are actively saying positive things (about immunizations), it changes peoples' perceptions."
Community engagement was just one tool supporting the project's primary goal: to empower family physicians and their staff to act to increase immunization rates, specifically among adolescents.
Supported by a three-year educational grant from the CDC, the project awarded individual grants to 20 practices to address the key areas of:
- strengthening physician recommendations for adolescent vaccines;
- reducing missed opportunities to immunize;
- increasing parental awareness and acceptance of adolescent vaccines, including addressing myths and misconceptions;
- implementing evidence-based practices to improve vaccine coverage; and
- sustaining action plan strategies in the long-term.
- During the AAFP Adolescent Immunization Office Champions Project Conference, participants discussed successes and challenges they've encountered while trying to improve adolescent immunization rates during the three-year initiative.
- Projects have been running at each practice since April 2013 and are scheduled to conclude Aug. 31.
- And overall, each practice showed marked improvement in adolescent immunization rates, especially with the HPV vaccine.
Projects have been running at each practice since April 2013 and are scheduled to conclude Aug. 31. And overall, each has shown marked improvement in adolescent immunization rates, especially for the HPV vaccine.
In addition to representatives from eight of the participating practices, two communications specialists from the CDC were on hand at the conference to hear about successful efforts the agency could possibly scale up as national initiatives and also to offer the CDC's perspective on the challenges of improving immunization rates. Also in attendance were representatives from the AAFP Health of the Public and Science's Immunization Advisory Group to guide discussions and answer vaccine questions.
Project Outcomes Highlighted
From June 2013, when baseline results were recorded at participating practices, to the final sustainability phase of the project in January 2015, HPV vaccination uptake for the full three-dose schedule increased 74 percent for females and 429 percent for males. In addition, administration of at least one dose of HPV vaccine increased 68 percent for females and 294 percent for males. Other vaccines also show increases during this period, including a 32 percent boost for meningococcal vaccine and a 20 percent increase for tetanus, diphtheria toxoids and acellular pertussis vaccine.
Project limitations included information technology issues within the AAFP METRIC (Measuring, Evaluating and Translating Research Into Care) Performance Improvement Module, which may have caused difficulties in charting data. Also, the recommendation for HPV vaccination in males was newly approved during this project, which could have skewed results. Finally, the initial 50-chart review requirement was difficult for some of the practices to meet because they didn’t have enough 13-year-old adolescents who fit the eligibility criteria.
Participants Discuss Their Experiences
During a conference breakout session, the group listens to Marlon Weiss, M.D., (center) of Family Practice Specialists LLC, explain that in his office, well-check visits are the first place they start advocating immunization to adolescents.
Project participants presented their results at the conference, including Janice Baker, M.D., of Chatham Family Practice in Chatham, N.J., who said that one of her challenges with the project was getting the 18 residents (who changed each July), seven faculty members and one nurse practitioner who see patients in her practice on board and educated about the project.
Baker said during the first two years of the project, her team saw parents frequently decline the HPV vaccine for their children despite the group's best efforts to encourage its use. But this year, things have changed.
"This year, fewer parents are giving the HPV vaccine such a hard time," she said. "They say, 'I've heard of this vaccine; yes, I think we should go ahead.' So I think things are starting to move in the right direction."
Baker said to sustain this push for adolescent immunizations, the practice plans to use standing orders that allow nurses to independently screen and administer vaccines, encourage walk-in visits for vaccinations, and actively continue to educate clinicians and patients and their families on the benefits of vaccinations.
Solo practitioner Timothy Tobolic, M.D., has served his community in Byron Center, Mich., for more than 30 years and said he found many creative ways to promote adolescent vaccines in his practice and community using project resources.
He started by using grant funding to purchase TVs for his waiting room and created patient education video content on immunizations to run in a loop on one television. On the other TV, Tobolic runs the local high school's cable access TV channel (that reaches 5,000 to 7,000 households) with which he partnered during the project to air CDC immunization and vaccine videos(www.youtube.com) (available on YouTube) between regularly scheduled programming.
Also during the first year of the project, Tobolic used readily available online CDC immunization materials(www.cdc.gov) to create his own hard copy materials targeted at students that could be handed out during the annual group sports physicals at Byron Center High School and Middle School. Additional outreach occurred at Boy Scout troop physicals, a community expo and at the local farmers market. More recently, he has collaborated with local nonprofit Byron Community Wellness Foundation to back the creation of additional handouts by students at the high school, with the idea that these materials would be crafted for and by their peers.
Andy Brothers, M.D., of Sutter Medical Group in Sacramento, Calif., explained during his presentation that his practice worked with its IT staff to create a registry of all adolescent patients to use to follow up with them regarding scheduled immunizations. Medical assistants in the practice then were assigned a minimum of five of these patients to call each day to schedule appointments for shots.
"That actually helped to bring a lot of adolescents in that we normally wouldn't have seen otherwise," Brothers said.
Focusing on the HPV vaccine, Bellinda Schoof, M.H.A., director of the AAFP's Health of the Public and Science Division, reminded conference attendees that it's important to get people out of the mindset that HPV vaccination somehow condones being sexually active and shift the focus to its role in cancer prevention.
"If someone says, 'My nine-year-old isn't going to have sex,' well that's why you want to give (the HPV vaccine) to them -- before sexual activity," she said.
CDC Health Communications Specialist Jill Roark said the HPV vaccine works best when given to patients who are ages 11-12 versus those who are older. She added that the most effective way to increase immunization acceptance continues to be a strong physician recommendation when discussing the adolescent immunization schedule with a patient.
"We need to routinely normalize HPV recommendations with other adolescent vaccines to see success," Roark said.
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