Racial and Ethnic Adult Disparities in Immunization Initiative

Racial and Ethnic Adult Disparities in Immunization Initiative CDC/NYS Nancy M. Bennett, M. D. , M. S. Monroe County Department of Public Health University of Rochester

Agenda • • Introduction/Overview of READII Primary Care Intervention Community Based Intervention Future Directions

Older Adult Immunization Rates Monroe County, 2001

Conceptual Framework READII Rochester Demand Access Provider behavior Health care system population Population Effective vaccine Briss et al, AJPM, 2000 Adapted from Briss et al, AJPM, 2000 Vaccination coverage

READII Rochester Overview 2002 Baseline Assessment Baseline rates from RDD survey 2001 Medicare sample 2003 Baseline rates in PCP’s 2002 -04 Intervention Community Intervention 2004 -05 Repeat Assessment Repeat Medicare sample Primary Care Continual monitoring Intervention Cost Effectiveness RCT Surveillance Public Education Health Department Initiatives

Influenza Vaccine Shortage 2004 • • Public clinics cancelled Communications cancelled Massive redistribution READII sites - vaccine supplied Partnerships - overall management Targeted projects - late in season Future vaccination efforts? ?

Agenda • • Introduction/Overview of READII Primary Care Intervention Community Based Intervention Future Directions

Primary Care Intervention: Objectives • Increase the proportion of adult neighborhood health center patients vaccinated: – Pneumococcal vaccine – Influenza vaccine • Study the value of tracking, recall and outreach in increasing vaccination rates.

Methods • Sites chosen for access to target populations - all have few resources • 7 sites for pneumo; 6 sites for flu • Internal medicine and family practice • All patients > 65 randomized to receive intervention early or late

READII Primary Care Intervention Tracking, Recall and Outreach (TRO) for adult vaccinations Home Visits (5%) Recall Patient Recall - phone (40%) Reminders Patient Reminders - mail (70%) Tracking (100%)

Pneumococcal vaccine: % up-to-date - end Year 1 • Among unvaccinated at beginning: – Control: 11% – Intervention: 55% P<. 001 • Among all active patients: – Control: 58% – Intervention: 85%

Pneumococcal vaccine: % up-to-date - end Year 1 Intervention Control Male 55% 12% Female 55 11 White 48% 10% Black 63 11 Hispanic 57 17 Other 47 6

Influenza Vaccination: % up-to-date - end Year 1 • Control: • Intervention: 22% 64% P<. 001

Influenza vaccination: % up-to-date - end Year 1 Intervention Control Male 64% 23% Female 63 21 White 68% 19% Black 60 25 Hispanic 51 25 Other 70 20

2004 -5 Vaccination Season Results

Agenda • • Introduction/Overview of READII Primary Care Intervention Community Based Intervention Future Directions

Community Advisory Board Members • • Community Based Organizations Senior Organizations Coalition of African American churches Influenza vaccine providers Health care providers - Primary Care Sites Insurers, managed care Medical Society MCDPH Immunization Program

READII Rochester Community Action Plan Communications Community Based Organizations Primary Care Practice Intervention Public Vaccine Providers Targeted Projects

READII Rochester: Communications • Face to face delivery by a trusted informant • Messages crafted by the African American community • Adult vaccines are important / safe • How and where to get vaccines • Racial and ethnic disparities

Bilingual Information Card

Community Based Organizations • CBO’s provided: Outreach and education to constituents, e. g. , foster grandparents, case management clients, Head Start • READII team provided: Vaccine promotion training Health education materials

Targeted Projects • Outreach in senior housing – Personal invitation to flu clinics – Residents scheduled for in-house clinics – Door to door follow-up • Outreach in churches – Speakers, print information, church bulletin inserts – Flu clinics available if requested

Influenza Immunization Rates Monroe County Health Survey, 2001 and Medicare Beneficiaries Study, 2003, 2004

Pneumococcal Immunization Rates, Monroe County Health Survey, 2001 and Medicare Beneficiaries Study, 2003, 2004

Take Home Messages • Outreach based at primary care sites was extremely effective in increasing rates of vaccination among seniors. • Community interventions increase awareness and education - engage community - but difficult to measure effectiveness.

Future Directions • Assess effect of practice based interventions on community rates • Measure cost effectiveness of outreach • Work with practices to sustain and institutionalize interventions • Apply outreach methods to improving other clinical services/PHS • Assess impact of improving rates on on on other PHS

Lessons Learned • Translation of evidence based strategies to community is critical • Simple randomized trial essential to assessing effectiveness • Must have trustworthy spokespeople from target population • Key to have centralized programculturally competent staff

Thanks to all our partners! Action for a Better Community Anthony Jordan Health Center BC/BS of the Rochester Area City of Rochester Mayor’s Office Community Nursing Center Congregation Healthy Heart Action Program (CHHAP) Culver Medical Group Finger Lakes Health Systems Agency Genesee Health Service HCR Health Reach Highland Family Medicine Center IBERO American Action League, Inc Lifespan MC Immunization Program MC Immunization Coalition Monroe County Medical Society Monroe County Office for the Aging The Monroe Plan North East Area Neighborhood Alliance NYSDOH Immunization Program Preferred Care Project Believe (U of R) Rochester General Hospital Rochester Primary Care Network Southwest Area Neighborhood Association St. Joseph’s Neighborhood Center Strong Internal Medicine Group Urban League of Rochester Westside Health Services Women’s Health Partnership