Adolescent Assessments An Idaho Perspective Idaho Immunization Program

Adolescent Assessments: An Idaho Perspective Idaho Immunization Program

Idaho Background • NIS-Teen publication • Adolescent AFIX visits in Idaho – Started in March 2008 – Goals: • Increase knowledge and utilization of adolescent vaccines among VFC providers • Raise teen immunization rates in Idaho

Adolescent AFIX • Idaho Adolescent AFIX visits consist of: – Reviewing the Standards for Child and Adolescent Immunization Practices – Adolescent assessment • Clinic selection for 2008 visits – 5% of VFC providers received an adolescent AFIX visit in 2008 • Adolescent only facilities selected received only an adolescent assessment • Family practice clinics received both an infant and adolescent assessment

Assessment Methods • Adolescent Assessments – Reviewed 30 patient charts for teens 13 -17 years • Definition of active patient: 1 visit in the past 2 years – State staff hand entered immunization histories into Co. CASA – Co. CASA Reports: • Adolescent Coverage Report – Antigens evaluated: 2 MMR, 3 Hep. B, 2 Varicella, 1 Td/Tdap, 1 Meningococcal, 3 HPV • Summary Report - to evaluate “missed opportunities” • List of Missing Immunizations

Feedback • Visit feedback presentation – Include key office personnel that can affect change – Highlight what is done well and can be improved upon – Review with the provider: • Adolescent assessment rates • Missed opportunities • Best-practice recommendations

Best-Practices • Common Best-Practice Recommendations – Develop a system to encourage patients to schedule a wellness visit at 11 -12 years of age – Review teen shot records during sports physicals and sick visits – Implement a reminder/recall system for teens – Follow only true contradictions to immunizations – Offer all ACIP recommended teen vaccines – Utilize IRIS (Idaho’s immunization registry)

Results

Immunization Successes • High Td/Tdap and Meningococcal rates • Adolescent AFIX visits promoted provider behavior change – 67% implemented at least 1 best-practice recommendation – 80% are now offering all ACIP recommended vaccines • A 33% increase from pre-visit data

Immunization Obstacles • Missed opportunities – 93% had a high percentage of missed opportunities; why? • 47% are not offering all ACIP recommended teen vaccines • 80% are not documenting varicella disease history • Screening teen immunization records at every visit – 40% of providers visited are not doing this • Picky specialty providers – Only 1 in 7 specialty providers visited offered all ACIP recommended vaccines for teens • Reminder/recall systems for teens – Providers visited rarely had a reminder/recall system in place for teens needing multiple doses of a vaccine

Conclusions • Adolescent immunization practices, education, and evaluation has largely been ignored until now • Adolescent assessments are an important tool to holistically evaluate a VFC providers practice and improve statewide adolescent immunization rates

Questions? Rebecca Coyle, Ms. Ed Program Manager Randi Wallace, MPH Adolescent Coordinator Idaho Immunization Program 450 W State St. , 4 th Floor PO Box 83720 Boise, ID 83720 -0036 Ph: (208)334 -5931