Assessment of Immunization Training Needs for Medical Assistants

1
Assessment of Immunization Training Needs for
Medical Assistants

• Melissa (Moose) Alperin, MPH, CHES
• Laura M. Lloyd, MPH, CHES
• Rollins School of Public Health
• Emory University
• 43rd National Immunization Conference
• Dallas, Texas
• Tuesday March 31, 2009

2
The Problem
3
Medical Assisting Profession

• One of nations fastest growing careers
• Many different duties, including
• preparing and administering immunizations
• Various professional preparation
• Formal education
• Certificate or diploma (6 month, 1 year)
• Associate degree (2 year)
• On-the-job trained

US Bureau of Labor Statistics
4
Alphabet Soup

• Accrediting Organizations for Educational
  Preparation Programs
• Commission on Accreditation of Allied Health
  Education Programs (CAAHEP)
• Accrediting Bureau of Health Education Schools
  (ABHES)
• Exam Administration / Professional Organizations
• American Association of Medical Assistants (AAMA)
  exam produces CMAs
• American Medical Technologists (AMT) exam
  produces RMAs
• Plus OJTs (on-the-job trained)
• As well as State Certification/Credentialing
  Bodies
• California Certified Medical Assistant (CCMA)
• Nationally Registered Medical Assistant
  (NRMA)/Nationally Registered Certified Medical
  Assistant (NRCMA)

5
Purpose of Project
6
Two-fold Purpose

• Provide data on
• the immunization-related training needs of
  current and future medical assistants and
• the existence of training and education materials
  targeting the medical assistant profession.

7
Survey Instrument
8
Web-based Survey

• 6 sections
• 25 questions
• Mostly closed-ended questions
• (with open-ended follow-up questions)

9
Survey Sections

• Definitions vaccination, immunization,
  immunization services, training
• Your Immunization Duties
• Training History
• Past Immunization Trainings
• Future Immunization Trainings
• Motivators and Barriers to Training
• Questions about You

10
Survey Review and Pilot Testing

• Review
• Project Team (APTR, CDC, Emory, ENMU-Roswell)
• Centers for Disease Control and Prevention
• Needs Assessment and Questionnaire Development
  Experts (Emory)
• Pilot Testing
• Practicing CMAs and RMAs (6)
• Medical Assisting Students at ENMU-Roswell

11
Methodology
12
Selection of Target States

• Twenty-four states selected based on
• Medical Assistant Presence Variable
• Geographic Region (Eastern US, Middle US, Western
  US)
• Consideration for OJTs (rural areas, physicians
  offices)
• Physicians offices (pediatrics, internal
  medicine, family practice, general practitioners,
  OB/GYN) in rural communities of four states were
  targeted
• defined by Primary Metropolitan Statistical
  Area (PMSA)

13
Final List of Targeted States

1. Alabama
2. Arizona
3. California
4. Florida
5. Georgia
6. Indiana
7. Iowa
8. Kansas
9. Massachusetts
10. Michigan
11. Mississippi
12. Nevada
13. New Jersey
14. New Mexico

1. North Carolina
2. Ohio
3. Oregon
4. Pennsylvania
5. South Carolina

1. South Dakota
2. Texas
3. Utah
4. Washington
5. Wisconsin

14
Survey Dissemination
15
Survey Dissemination (targeted states)

• Postcard sent to
• AAMA Membership (Active and Associate) N10,109
• Rural Physicians (pediatrics, internal medicine,
  family practice, general practitioners, OB/GYN)
  4 targeted rural states N4,177
• Email sent to
• Community Health Centers (HRSA-funded) N671
• Community Health Centers Look Alikes
  (HRSA-funded) N56 
• CAAHEP Programs N409
• ABHES Programs N86
• AAMA Local Chapters N46
• State Immunization Registries N26 
• VFC Programs N24

16
Survey Dissemination (national)

• Email sent to
• AAMA State Society Presidents and
  Presidents-Elect
• Professional Association of Health Care Office
  Management
• American Academy of Pediatrics (AAP) Chapter
  Executives
• Immunization Action Coalition article for IAC
  Express newsletter
• Announcements on national websites
• American Association of Medical Assistants
  (AAMA) 
• Association for Prevention Teaching and Research
  (APTR)
• CDC Vaccine and Immunizations

17
(No Transcript)
18
Survey Results
19
Final Group of Respondents

• 2730 Started survey
• 2426 Worked at MA
• 2089 Worked in immunization services
• 1977 Answered remainder of survey

20

• Questions about Respondents

21
Demographics

• Ave. age 38 years (19-72 yrs)
• Gender 97 female
• Ave. years worked as MA 9 years (0-42 yrs)
• From targeted states 82
• Urban/Suburban areas 72 (and 28 rural)

22
Education to Become MA

• 53 graduated from MA program and CMA
• 25 graduated from MA program
• 10 graduated from MA program and RMA
• 8 on-the-job trained
• 4 other

23
HealthCare Settings

• 71 Physicians Office
• 11 Community Health Center
• For those who work in physicians office
• 41 work in Family Practice office
• 31 work in Pediatrics office
• 64 of settings were enrolled as VFC provider

24
Types of Immunizations Given

• 29 Adolescent immunizations
• 29 Childhood immunizations
• 28 Adult immunizations
• 13 Vaccines for international travel
• 2 Other
• Other included responses such as tetanus
  shots, allergy shots, antibiotics, growth
  hormone, Vitamin B12

25

• Immunization Duties

26
Immunization Tasks

• More than 70 of respondents often
• Record keeping and/or documentation in patient
  record (88)
• Administering vaccines (81)
• Storage and/or handling of vaccines (80)
• Educating patients/parents (78)
• Screening patients (74)
• More than 40 of respondents never
• Coding and/or billing of immunization services
  (41)
• Assessing immunization rates (54)

27

• Training History

28
When Participate in Training

• When participate in immunization trainings
• When a doctor or other medical staff offers
  training in their office setting (26)
• When there is a change in immunization
  recommendations (22)
• When a new vaccine is licensed (20)

29

• Past Immunization Trainings

30
Past Immunization Trainings

• 52 have been provided by in-service in office
  (either by office staff or other lecturers)
• 26 have been sponsored by in-house staff and 23
  by vaccine manufacturers or representatives
• In-house staff used 22 of time to update
  knowledge, vaccine manufacturers used 19, and
  CDC used 18

31

• Future Immunization Trainings

32
Important Training Topics

• Top Training Topics
• Adverse reactions or side effects(91)
• Educating patients/parents (89)
• Administering vaccines (88)
• Risk communication (88)
• Record keeping and/or documentation in patient
  record (87)
• Immunization schedules (87)
• Storage and/or handling of vaccines (86)
• Clinical information about disease (85)
• VISs (84)
• Screening patients (82)

33
How Receive Trainings

• Over 80 prefer
• In-service by other lecturers (86)
• In-service by staff in your office (84)
• Over 50 do NOT prefer
• Satellite broadcast, webcast, or net-conference
  where there is no interaction with the instructor
  (54)
• Audio recording (60)
• Preferred educational strategies
• Problem-based learning (79)
• Case studies (74)

34

• Motivators and Barriers to Training

35
Motivators and Barriers

• Top motivators
• Learning new or updated information (e.g., new
  schedule or new recommendations) (95)
• Requirement for current job (94)
• Top barriers
• Finding time during work schedule (46)
• Not aware of available trainings (45)
• Cost of trainings (43)

36

• Communicating with Medical Assistants

37
Communicating About Future Trainings

• Best way to inform MAs about future trainings
• Email communications (39)
• Direct mailing through US postal system (30)
• Announcement through vaccine manufacturer (10)
• Announcement from CE provider (7)
• Announcement on website (6)
• Preferred websites for announcements
• State immunization registry website (25)
• CDC website (21)

38
Recommendations

39
Advocacy

• Advocate for professional preparatory standards.
  
• Partner with medical and nursing associations to
  facilitate communications with MAs, to advocate
  the ongoing need for immunization training and to
  encourage valuable support and recognition of
  MAs.
• Advocate for a national mechanism (e.g.,
  registry) to collect contact information for MAs
  regardless of educational preparation or
  membership in a professional association.
• Advocate for uniform regulation of the medical
  assistant profession.

40
Communication

• Announce training availability and updated
  information via email, direct mail and key
  websites (e.g., immunization registry sites,
  CDC).
• Communicate training opportunities to worksite
  supervisors.
• Communicate to worksite supervisors the
  importance of ongoing updates and immunization
  training for MAs.

41
Training

• Focus immunization-related trainings on adverse
  reactions or side effects educating
  patients/parents (i.e., health communication)
  administering vaccines risk communication
  (e.g., discussion of vaccine safety) record
  keeping and/or documentation in patient record
  immunization schedules storage and/or
  handling of vaccines clinical information
  about disease VISs and, screening
  patients.
• Develop case studies and problem-based learning
  activities.
• Develop short, modular training units that
  incorporate case studies and problem-based
  learning.

42
Training

• Deliver trainings for MAs as in-services by
  either in-house staff (e.g., nurse, medical
  staff) or by other lecturers (e.g.,
  pharmaceutical representatives, nurse from
  technical college, public health staff).
• Utilize a train-the-trainer methodology that
  incorporates these modular training units, to
  support worksite supervisors as they train MAs.
  
• Partner with VFC program to facilitate the
  development and dissemination of training
  opportunities for MAs in VFC settings.
• Offer CEUs as an incentive for MAs, particularly
  CMAs and RMAs, to attend trainings.

43
Training

• Explore strategies to offer no-cost or low-cost
  training to MAs by collaborating with other
  agencies (e.g., state immunization programs,
  professional organizations, pharmaceutical
  companies).
• Market available continuing education offerings
  to MAs and their supervisors and clarify that
  many trainings offer CEU credit that CMAs and
  RMAs may be able to use.
• Develop immunization-related training materials
  at an instructional level appropriate for the
  diversely-trained population of MAs.

44
Acknowledgements

45
Project Partners

• Eastern New Mexico University, Roswell
• Division of Health
• Jane Batson, RN, MSN
• Cheryl Vineyard, BS, CMA
• Rollins School of Public Health,
• Emory University
• Melissa (Moose) Alperin, MPH, CHES
• Ann Duttera Council, MPH, CHES
• Laura M. Lloyd, MPH, CHES
• Kathleen R. Miner, PhD, MPH, CHES
• Tim Underhill

• Association for Prevention Teaching and Research
  (APTR)
• Donna A. Page, MPH, CHES
• Centers for Disease Control and Prevention
• Jennifer Hamborsky, MPH, CHES
• Bette Pollard, MPH, CHES

• The Assessment of Immunization Training Needs and
  Educational Products and Programs for Medical
  Assistants Project was funded through the Centers
  for Disease Control and Prevention (CDC) and the
  Association for Prevention Teaching and Research
  (APTR) Cooperative Agreement No. U50/CCU300860. 
  The findings and conclusions in this report are
  those of the author(s) and do not necessarily
  represent the views of the Centers for Disease
  Control and Prevention or the Association for
  Prevention Teaching and Research.

46
Contact Information

• Melissa (Moose) Alperin, MPH, CHES
• Rollins School of Public Health, Emory University
• malperi_at_emory.edu
• Laura M. Lloyd, MPH, CHES
• Rollins School of Public Health, Emory University
• lmlloyd_at_sph.emory.edu