CDC Asks for Help

28 06 2012

(From the CDC and HHS)

June 26, 2012

Dear Pharmacists and Community Vaccinators,

Thank you all for your tremendous efforts this past year to raise immunization rates in the United States. Outbreaks of pertussis (“whooping cough”), influenza, and measles, and continued low vaccination rates for human papillomavirus (HPV), Tdap (tetanus, diphtheria, and pertussis), zoster vaccines and others are critical reminders of the ongoing efforts that are needed.

Pharmacists and community vaccinators are uniquely positioned to promote and provide vaccines to people in a wide range of communities. In addition, their extensive reach into diverse communities allows greater access to vaccines for those who may not have a medical home, and who traditionally have had lower rates of vaccine use.

The Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (DHHS) ask for your continued support and efforts to help address vaccination needs in your communities. We know you are asked to do a lot to help your patients, but as trusted health care professionals, research shows that your recommendation to receive needed vaccines is vital.

As just one example, only about 10 percent of adults living with an infant report having had Tdap vaccination.1 But, a 2012 survey conducted by Harris Interactive found that 45% of unvaccinated adults who have been in contact with babies under 2 years in the past 5 years or expect to be in contact with them in the next 12 months would consider getting Tdap vaccine if a family member asked. However, 83% would consider getting Tdap vaccine if they were asked by their doctor or other healthcare professional.2 These results underscore the importance of your recommendation for protecting your patients and their families.

Specifically, CDC and HHS are asking pharmacists and other vaccine providers to:

1. Increase awareness among their patients about recommended vaccines, especially for adults and adolescents where vaccination rates are lagging.

2. Ensure that the people who visit your pharmacies or clinics are aware of which vaccinations they need by assessing their vaccine needs and offering those vaccines, e.g.:

a. Offer Tdap vaccine to replace one dose of Td. This is especially important for anyone who will be around infants given outbreaks of pertussis in the United States.

b. Inform pregnant women that they are recommended to receive Tdap vaccine after week 20 of pregnancy and influenza vaccine anytime during pregnancy.

c. Offer yearly influenza vaccine for everyone 6 months and older.

d. Offer zoster vaccine for adults 60 years and older.

e. Offer pneumococcal polysaccharide vaccine for everyone 65 years and older.

3. For patients with certain medical conditions, recommend and offer vaccinations specifically recommended based on their high risk conditions, e.g.:

a. Remind patients with diabetes that they need influenza vaccine, pneumococcal polysaccharide vaccine, and hepatitis B vaccine.

b. Consider targeting immunization messages to patients within your prescription database based on their medications and/or age.

c. Incorporate immunization reminders to patients and caregivers during counseling and medication therapy management (MTM) encounters.

4. Enter adult immunizations into vaccine registries (i.e. immunization information systems) in states where this is possible and provide documentation to the patient (consent form and/or immunization card) and/or their primary care provider to ensure appropriate recording of immunizations.

5. Partner with state and local health departments, immunization coalitions, medical providers, and others in your communities to increase collaboration and outreach to those who need vaccines.

Details about the vaccines recommended for adults and for children can be found at:

http://www.cdc.gov/vaccines/ and an adult scheduler and “quiz” for patients to find out which vaccines they may need can be found at http://www.cdc.gov/vaccines/schedules/Schedulers/adult-scheduler.html. Additional information about pertussis for patients and healthcare professionals can be found at www.cdc.gov/pertussis/index.html.

Additional links to find contacts for state and local health department immunization programs and coalitions, and educational resources for vaccine providers and patients are included below.

Thank you, again, for your energy, enthusiasm, and efforts in improving the health of our communities.

Sincerely,

Anne Schuchat, MD

RADM, US Public Health Service

Assistant Surgeon General

Director, National Center for Immunization and Respiratory Diseases

Immunization education and outreach resources and links to identify contacts in state immunization programs and immunization coalitions

State immunization program managers

These individuals are the state point of contact for immunization efforts and are usually housed within the state health departments.

Further information is available at the following link: http://www.immunizationmanagers.org/about/index_about.phtml

Vaccines for Children (VFC) Program

The VFC program is a federal program that provides vaccines to uninsured children at no cost to the child or their family.

Information on contacts for the VFC program in each state and certain cities is available at the following link: http://www.cdc.gov/vaccines/programs/vfc/contacts-state.htm

Further information about Vaccines for Children Program is available at:

http://www.cdc.gov/vaccines/programs/vfc/default.htm.

Information addressing pharmacists and the VFC program is available at:

http://www.cdc.gov/vaccines/programs/vfc/projects/faqs-doc.htm#enroll

State vaccine registries/immunization information systems

Can your pharmacy participate in your state’s immunization registry? Contact the state immunization registry person to find out if this is an option in your state. Participating in state immunization registries can greatly help facilitate communication about vaccination between providers.

Further information is available at the following link:

http://www.cdc.gov/vaccines/programs/iis/contacts.htm

Immunization coalitions

There are numerous immunization coalitions around the country, pulling together partners from diverse sectors to unite efforts to improve immunization rates.

Further information about linking to coalitions is available at the following site:

http://www.izcoalitions.org/

Free communications resources

CDC produces a variety of resources to promote immunizations, such as print materials, audio/video tools and web tools that can be downloaded free of charge. Immunization campaign materials can be found at http://www.cdc.gov/vaccines/campaigns.htm and support childhood, adolescent and adult immunization with some materials also available in Spanish.

The Immunization Action Coalition has many different handouts on a variety of vaccines that can be downloaded free-of-charge from their website. More information can be found at: http://www.immunize.org/handouts/.

National, regional, and state Offices of Minority Health contact information

The US Department of Health and Human Services has both federal and regional Offices of Minority Health and states also have Offices of Minority Health.

Pharmacies interested in collaborating with these offices to reduce disparities in vaccination may contact these offices at the following links.

Office of Minority Health, Office of the Secretary:

http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=7

Offices of Minority Health in Regional Offices:

http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=188

Offices of Minority Health in States:

http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=187

Interactive adult and child schedulers

Do you know about the interactive adult and child schedulers? Immunization schedules are complex….and always changing. The CDC website has tools that allow you to enter key patient information and produce an individualized immunization schedule. Patients really like to see that one-of-a-kind individualized, customized set of immunization recommendations, along with their pharmacist’s recommendations.

Further information regarding the schedulers is available at the following link: http://www.cdc.gov/vaccines/programs/default.htm.

Preventing Vaccine Administration Errors

As a refresher for healthcare providers on correct vaccine administration technique and vaccine-related adverse events, please consult these resources:

1. Guidance from the Pink Book:

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/D/vacc_admin.pdf.

2. Quick Fact Sheet: http://www.immunize.org/catg.d/p3085.pdf.

3. Vaccine Administration Technique video: http://www.immunize.org/dvd/.

4. Institute of Medicine report on Adverse Effects of Vaccines: http://www.nap.edu/catalog.php?record_id=13164#toc.

To report adverse events, see the Vaccine Adverse Events Reporting System at: http://vaers.hhs.gov/index.

Immunization training offerings

CDC invites pharmacists to take advantage of CDC immunization training offerings. The most recent summary of all the new immunization developments and recommendations can be found in CDC’s Immunization Update 2012, scheduled for August 4, 2012.

Please visit the following link for further information:

http://www.cdc.gov/vaccines/ed/imzupdate/default.htm

These programs supplement pharmacist-specific immunization education programs provided by pharmacist associations. Check with your pharmacist association for additional training and support resources such as web-based immunization resources, discussion groups and electronic newsletters.

1 Centers for Disease Control and Prevention (CDC). Adult Vaccination Coverage — United States, 2010. Morb Mortal Wkly Rep 2012;61(04);66-72. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a2.htm.

2 Online survey of 4,247 adults ages 18 and older, of whom 237 were parents of children aged 2 and under, conducted by Harris Interactive on behalf of Sounds of Pertussis®, May 9-11 and May 11-15, 2012.





Healthy People 2020

21 03 2011

In 1979, the U.S. Department of Health and Human Services’ (HHS) Healthy People program debuted in the form of a surgeon general’s report. Since then, every 10 years (starting in 1990), scientists meet to try and figure out what’s needed and what’s feasible for the good of public health. 

The updated Healthy People 2020 website has a full list of objectives, along with resources to help health departments and organizations achieve those objectives.

We spoke with Carter Blakey, Acting Deputy Director of the Office of Disease Prevention and Health Promotion (ODPHP), about how nongovernment organizations can get involved. “Health is very complex, there are lots of different factors,” Carter said. “It takes more than the federal government to change health.”

The Healthy People 2010 objectives were very ambitious, Carter admitted. All the goals rolled into achieving the objective of “eliminating disparities. The goals were set to be better than the best communities in the country.”

Carter said that some goals were set 1,000% above the national average. Some groups were very motivated by this and others were very discouraged because they thought the goals were impossible.

The 2020 goals are more realistic with a little bit of a stretch. “It will be interesting to see if we are able to meet more of our goals. Moving the needle takes a long time, many years.”

It’s up to States and organizations to tackle the objectives and make a real impact in their communities. While States are not required to participate in the Healthy People program, many do, and have a dedicated State Coordinator to help organize activity.

There is funding available for States, Territories, and Tribes that have an innovative plan to use Healthy People 2020 to improve a community’s health. The Healthy People Action Project proposals are due on April 1, 2011.

Beyond that specific grant, organizations can use the Healthy People benchmarks as data to support applications for grants or other funding opportunities by comparing their communities to the national average.

What goals are you most interested in tackling in the next decade? Where do you see the need to collaborate most to achieve these goals? We’d love to hear from you in our comments.





Improving Health Literacy

21 06 2010

Nearly 9 out of 10 adults have problems understanding and using basic health information.

Insufficient health literacy (a person’s ability to understand health information) is not limited to a select group.  It cuts across all cultures, levels of education and income, and all age groups.

We need to be educated to improve our health literacy, so that we can make optimal health-related choices.

Toward this end, the Department of Health and Human Services, led by Howard K. Koh, M.D., M.P.H., Assistant Secretary for Health, has developed the National Action Plan to Improve Health Literacy.

The plan does a good job of outlining the barriers to health literacy, identifying goals, and providing some steps to reach those goals:

  • Develop and disseminate health and safety information that is accurate, accessible, and actionable
  • Promote changes in the health care system that improve health information, communication, informed decisionmaking, and access to health services
  • Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in childcare and education through the university level
  • Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community
  • Build partnerships, develop guidance, and change policies
  • Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy
  • Increase the dissemination and use of evidence-based health literacy practices and interventions

The American Medical Association (AMA) Foundation has done a lot of work over the years toward improving health literacy, providing helpful tips and tools to physicians to improve communication and understanding between patients and providers.

In fact, lots of groups are working on health literacy.  If you search the term on the Internet, you’ll get half a million results or more.

If so many people are working on it, why is it still a problem?

It’s a tough nut to crack. Low literacy is a key factor in non-compliance with healthcare recommendations. For example, if the directions for taking medication are complicated, or the instructions for recovery from surgery are hard to understand, chances are patients will be reluctant to ask for help in deciphering the language and therefore they will not be able to follow the directions. In other words, they become non-compliant.

Unfortunately, many healthcare professionals don’t always know why a patient is not responding to treatment.  They may not know that there’s a non-compliance issue and that it’s connected to low health literacy.

Low health literacy plays a significant role in:

For the health of our population, we as educators need to become better at finding ways to improve health literacy. Perhaps Dr. Koh’s plan will blaze some trails.

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