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INCREASING UPTAKE OF ADOLESCENT VACCINES IN NC SCHOOL HEALTH CENTERS
Ashley Leighton, MPHCervical Cancer-Free NC
Cathy DeMason, RN, BSNDirector, Rockingham County Student Health Centers
Rockingham County Student Health Centers
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CCFNC is funded by an unrestricted educational
grant from GlaxoSmithKline.
Conflict of Interest Statement
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Background and FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention
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Background and FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention
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Becoming Cervical Cancer-Free
Cervical cancer is fully preventable through screening and vaccination
Each year 300 women in North Carolina die from this preventable disease
CCFNC’s priorities are vaccination and screening
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The Carolina Framework identifies 4 main causes of cervical cancer deaths:•HPV infection•Lack of screening•Screening errors•Not receiving follow-up care
Carolina Framework
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Becoming Cervical Cancer-Free US uptake of HPV vaccine lags behind
Source: NIS-Teen 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a1.htm?s_cid=mm6033a1_w
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Let’s make HPV vaccine part of routine adolescent care.
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Why schools?
Meet adolescents where they are Adolescents least likely to see doctors School health centers often already
equipped to administer vaccines Other countries with high rates of HPV
uptake have utilized school settings
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A step back
How can we help school health centers increase uptake of adolescent vaccines?
Let’s ask them!
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School Health Advisory Board Created Advisory Board with
representatives from NCSCHA, DPH, DPI, Immunization Branch, school health center staff, and others with SHC expertise
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Background and FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention
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SHC survey
Fall 2010
Topics Barriers to HPV vaccine Potential interventions
Partnership with NCSCHA
33 SHCs offering HPV vaccine
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SHC survey results
School health centers are already doing a lot!
37% Asking parents for consentwhile they are at school
42% Printing and mailing letterendorsing adolescent vaccines
82% Parent reminders that childrenare due for adolescent vaccines
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SHC survey results
Several barriers still existBarrier
(%)Greatest
Concern (%)
Out-of-pocket costs for children to receive privately purchased HPV vaccine 79 51
Upfront costs of ordering and stocking the privately purchased HPV vaccine 67 30
Inadequate reimbursement by insurance companies for providing privately purchased HPV vaccine
42 18
Out-of-pocket costs for children to receive VFC supplied HPV vaccine 33 21
Students not returning the consent form 76 21
Obtaining records of prior immunizations 61 6
School administrators’ concern that providing HPV vaccine will take students away from classes
21 0
Cost
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SHC survey results 82% of school health centers interested in
interventions but many had limited staff
Most do-able interventions: student incentives for getting adolescent vaccines printing and mailing letters endorsing adolescent vaccines
Interventions rated most likely to work: student incentives for getting adolescent vaccines parent reminders for adolescent vaccines asking parents for consent while they are at school
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Background and FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention
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Creating an action plan
Demonstration project…
Cost barrier…
Consent barrier…
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Bringing on partners
School health centers with Interest in
partnership Proximity to CCFNC
office Strong leadership
Rockingham County Student Health
Centers
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Designing an intervention
Create materials that make the consent process easier for parents
Make sure the materials Are easy to use (especially consent form) Promote adolescent vaccines Highlight convenience of SHCs Use voices and images of parents and
students
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Testing materials
9 parents 4 Rockingham3 Durham2 other counties
12 SHC staff7 directors or managers of SHCs
5 nurses and other clinical staff
Cognitive interviews Online survey
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Background and FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention
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Other elements
STAMPED and addressed return envelope
Movie ticket drawing
Other incentives
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Implementation
CCFNC printed and prepared packets
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Implementation
Rockingham SHCs took the lead from
there
Distribution and mailing of packets
Reminder auto-calls
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Implementation
Surprising amount of phone calls regarding cost of vaccines
Additional letter sent to parents with private insurance
Materials needed to make costs clearer
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Evaluation: Process CCFNC tracking hours, costs, time
Rockingham staff tracking Packet and letter distribution Data from received consent forms Costs Hours
Bi-weekly partner meetings
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Evaluation: Process
Phone interviews with parents are underway
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Evaluation: Outcome
Tracking Doses
Comparison sites
Results forthcoming
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Challenges
Phone calls from parents Cost Vaccine history
Time Ordering vaccines Incidental change in Health Choice
insurance from BC/BS to Medicaid caused confusion
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Successes
A good amount of forms have come back to SHCs
Children are getting vaccinated
Strong partnership Parents are asking
questions and getting educated
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Next Steps
Results and materials will be available next year
Implementation Guide
Research-to-Practice Report
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Next Steps We hope materials will be useful for…
School health centers Mass vaccination clinics Future partnerships
Contact us if you are interested! [email protected]
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Acknowledgements
Rockingham County Student Health Centers staff
Rockingham County parents and students
SHC staff who took time out of their busy schedules to participate in interviews
School Health Center Adolescent Immunization Advisory Committee Amanda Dayton (NC Division of Public Health) Cathy DeMason (School health center representative) Anne Derouin (School health center representative) Dan Garsen-Angert (NC Division of Public Health) Chris Minard (NC Department of Public Instruction) Connie Parker (North Carolina Community School Health Alliance) Carol Tyson (NC Division of Public Health)
CCFNC staff and students