Aging

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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

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• 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

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• 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

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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
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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

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Recommended Adult Vaccines

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

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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

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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

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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

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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

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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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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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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/
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More resources

• Partnership for Prevention Strengthening Adult
  Immunization A Call to Action www.prevent.org/pub
  lications/CalltoAction.pdf
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• 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
•  

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Action for Community Enrichment Coalition (ACE)
An Approach to Influenza and Pneumonia
Immunization

• Anne Bailowitz, MD, MPH
• Baltimore City Health Department
• August 31, 2005

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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

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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

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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

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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

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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

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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

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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

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Outcomes - 2

• Hammer Award for Reinventing Government 2000
• Maryland Immunization Excellence Award - 2004

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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

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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

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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

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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

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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

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Lessons Learned - 3

• Homebound services
• Minimize paperwork
• Vaccine production and distribution issues

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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

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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

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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)

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North Texas Adult Immunization Coalition

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

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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.

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The Beginning

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

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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.

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• 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

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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.

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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.

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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.

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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.

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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.

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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).

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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.

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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.

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• 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!

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Success

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

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Salt Lake County Aging ServicesShauna ONeil,
Director

• Flu Vaccination
• a part of the
• Healthy Aging Program

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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

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Health Screening

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

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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

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Funding

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

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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

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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

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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

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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

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For further information

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

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More Best Practice Programs

• Catherine Gordon
• Senior Public Health Analyst
• Office of the Director
• CDC

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Innovative Approaches

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

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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)

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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

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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

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ResourcesInfluenza and Pneumococcal Vaccinations

• Jacqueline Harley
• Office of Clinical Standards and Quality
• Centers for Medicare Medicaid Services

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• 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

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• 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

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• 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

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•  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
•  

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• 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

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• 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

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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

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