Increasing ( Late Season ) Influenza Vaccinations- Baton Rouge

1. Increasing (Late Season) Influenza Vaccinations- Baton Rouge William Cassidy, MD Louisiana State University Health Sciences Center

2. LSU Dale Marrioneaux Aubrey Lipham Sal Baghian Baton Rouge General Staff Our Lady of the Lake Staff CDC Dan Fishbein Susan Manning Edith Gary Acknowledgements

3. Outline • Question • Reasons for low immunization rates • Phases of “Baton Rouge” Effort • Isolating variables • Results • Conclusions

4. Question Are reasons for decreased late season flu immunization different from reasons for decreased early season flu immunization.

5. Outline • Question • Reasons for low immunization rates • Phases of “Baton Rouge” Effort • Isolating variables • Results • Conclusions

6. Patient Reasons to be Un-Vaccinated • InadequateKnowledge, Attitudes & Practices (KAP) • knowing, caring or wanting • Expense • Direct cost of vaccine & MD visit • Indirect cost of missing work

7. Providers Reasons to not Vaccinate • Inadequate Provider KAP • Non traditional providers (ex. ER Docs) • Extension of vaccination season • Direct and Indirect “Costs” • Cost of vaccine and vaccination • Counseling can be very time consuming

8. Outline • Question • Reasons for low immunization rates • Phases of “Baton Rouge” Effort • Isolating variables • Results • Conclusions

9. Phase 1 of 4, Assessment/Reminder forms for 6 vaccines in 3 Primary Care Settings Results: No significant increase in immunizations in the intervention group. Conclusions: Providers did not give recommended vaccines, unable to assess effect of increasing patient KAP

10. Phase 2 of 4 Para-professionals approached ED patients, Immediate vs. Later Vaccination

11. Phase 2: Indirect Cost to Patients • Results - Immediate vaccination with greater acceptance rate. • Conclusions – Eliminating patient’s indirect costs significantly increases vaccination coverage • Note: Provider role eliminated

12. Phase 3 of 4, Para-professionals Using A/R Forms, Patients Randomized to $0, $5, $10 Co-pay

13. Phase 3: Varied Patient Direct Costs • Results • Incremental increases in a patient’s direct cost decreased vaccination acceptance • Conclusions – • ED immunization facilitated by para-professionals feasible • Note: Providers minimally involved

14. Phase 4a of 4, City WideEffort: Para-professionalsUsingA/R Forms, Providers signing standard orders Results: Anomalous year Larger ED with better cost benefit ratio

15. Phase 4b, Baton Rouge Efforts • November 2005 – March 2006 • Larger hospital assessed 24/7 • Smaller hospital assessed 10 A to 10 P • Physicians signed standard orders • Nurses vaccinated

16. Phase 4b of 4, Para-professional -A/R Forms, Providers signing standard orders 2 Busiest Emergency Departments

17. Racial Disparities

18. Influenza Vaccination, Patients in ACIP Risk Groups by Race, Hospital A ED, Dec. 5-Feb. 16 * *

19. Influenza Vaccination, Patients in ACIP Risk Groups by Race, Hospital A ED, Dec. 5-Feb. 16

20. Question Are reasons for decreased late season flu immunization different from reasons for decreased early season flu immunization.

21. Late Season Immunization No significant decrease in late and early season acceptance of flu immunization

22. Patient Reasons to be Un-Vaccinated • InadequateKnowledge, Attitudes & Practices (KAP) • Direct and Indirect “Costs” Providers Reasons to not Vaccinate • Inadequate Provider KAP • Direct and Indirect “Costs”

23. Overall Conclusions • Para-professionals in EDs can increase patient’s KAP towards flu vaccination • Eliminating patient’s direct & indirect cost increases immunization rates • ED immunization decreases disparities • Providers: Role is problematic

24. Conclusions of Phase 4b • Late flu season immunization is feasible and accepted by patients. • Patient issues with late flu immunization are the same as early season issues • Provider issues may be important

25. Outline • Question • Reasons for low immunization rates • Phases of “Baton Rouge” Effort • Isolating variables • Results • Conclusions