Page 10 - Kansas Journal of Medicine, Volume 10 Issue 4
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KANSAS JOURNAL of  MEDI CIN E                                Healthy People 2020 goals include increasing routine vaccination
                                                               coverage in adolescents (ages 13 - 15 years), with targets set for each
                                                               vaccine of 80%.  In 2015, no state met the target coverage for the
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                                                               HPV vaccine series.  HPV is the most common sexually transmit-
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                                                               ted infection and young people aged 15 - 24 years account for half of
        Kansas Provider Report of Adolescent                   new infections each year. The HPV vaccine protects against the most
              Vaccinations in Their Practice                   virulent strains.  In the most recent data, 47 states met the Healthy
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             Serina Padilla, M.D., Gretchen Homan, M.D.,       People 2020 target for Tdap vaccine and 36 for MCV, while Kansas
         Matt Engel, MPH, Carolyn R. Ahlers-Schmidt, Ph.D.,    had the third lowest rate in the nation for HPV vaccination initiation
                         Kari Harris, M.D.                     for girls and was the fifth lowest-ranking state for MCV vaccination.
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           University of Kansas School of Medicine-Wichita,       Providers are key players in vaccine uptake by patients. Provider
                      Department of Pediatrics                 encouragement is one of the key reasons parents choose to vacci-
                                                               nate their children.  Likewise, provider hesitancy in vaccine safety
                                                                               8,9
     ABSTRACT                                                  or efficacy discourages uptake of vaccines by patients.  Vaccination
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     Introduction. Kansas falls consistently below average for adoles-  rates vary widely across Kansas with urban centers typically having
     cent vaccination of meningococcal (MCV), human papillomavirus   higher rates.  Clinical practices performing well in vaccination may
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     (HPV), and influenza.                                     have successful policies and protocols in place, but these may not be
     Methods. For this study, the members of Kansas Chapter of the   shared between practices. Methods shown to be effective in increas-
     American Academy of Pediatrics were emailed a confidential elec-  ing adolescent vaccine uptake include patient reminder and recall
     tronic survey soliciting their impressions of vaccination in their   systems, provider reminders, standing order sets, and immunization
     practice.                                                 information systems (IIS; formally called vaccine registries).
                                                                                                                 8,11
     Results. Of 137 providers emailed, 61 (45%) completed the survey.   States are incentivized through Medicaid payment models to have
     Thirteen providers were excluded as they did not see/vaccinate ado-  an IIS; WebIZ is Kansas’ IIS. The goal of IISs is to serve as a portable,
     lescents or did not complete the survey. Tetanus, diphtheria, pertussis   complete record for the patient, which is especially important if vac-
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     (Tdap), and MCV vaccines were most commonly up to date with   cines have been received in multiple locations.  State IISs protect
     31 (65%) and 20 (42%) respondents reporting greater than 90%   patients and enhance health and safety by supporting communica-
     immunization rates, respectively. HPV (n = 42, 89%) and influenza   tion between immunization providers. IISs can integrate with the
     (n = 40, 83%) vaccines had refusal rates greater than 25% in most   provider’s electronic health record software, minimizing potential
     clinics. Most practices (n = 44, 92%) used internal electronic medical   data entry errors, use information from the CDC to build decision
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     records to track vaccinations, although 29 practices (60%) utilized   support features, and stay current with updates from that agency.
     the state immunization information system. Providers requested   Reminder/recall systems also have been shown to increase overall
                                                                                            7,13
     vaccine-specific patient education tools, positive media coverage,   vaccination rates for adolescents.  These systems may originate
     staffing support, and best-practices workshops to support vaccina-  from the particular electronic health record system or from the state
     tion efforts.                                             IIS. Further, adolescents, including those from underserved and
     Conclusion. Kansas providers may not be optimizing available   ethnic minority groups, are receptive to the idea of receiving health
     resources to enhance these rates, such as Web IZ tracking and immu-  information via text messaging and are interested specifically in
     nization reminders. Patient education supplies, specific to HPV and   immunization reminders. 14,15
     Influenza vaccination, potentially could increase vaccination rates.   Despite these strategies, barriers to effective vaccination for
     KS J Med 2017;10(4):84-87.                                adolescents remain. This study aims to evaluate vaccination prac-
                                                               tices in Kansas, determine barriers to vaccination, and identify tools
     INTRODUCTION                                              providers perceive would be beneficial to increase vaccination rates
        Vaccines are readily available in the United States and provide an   in adolescents.
     opportunity to prevent morbidity and mortality. Recommendations
     for adolescents by the Centers for Disease Control and Prevention   METHODS
     (CDC) include tetanus, diphtheria, and pertussis (Tdap) vaccine at   This was a mixed-methods cross-sectional evaluation of provider’s
     age 11 - 12 years, three doses of human papillomavirus (HPV) vaccine   understanding of adolescent vaccination in their practice. A survey
     starting at age 11 - 12 years, meningococcal conjugate vaccine (MCV)   was developed with input from pediatricians and researchers. The
     at age 11 - 12 years with a booster at age 16 years, and influenza vaccine   survey asked about practice characteristics, provider’s interpreta-
     annually.   Of these recommended vaccinations, only Tdap is required   tion of vaccination practices and coverage, and what resources might
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     by the public school system in Kansas.  MCV often is required prior   improve vaccination coverage.
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     to college attendance. Required vaccination for school attendance is   The Kansas Chapter of the American Academy of Pediatrics
     effective in increasing vaccine coverage.  In part, because of the lack   (KAAP) provided a list of email addresses for their members.  Sur-
                                      3,4
     of requirement for HPV vaccine in Kansas schools, there is the poten-  veyMonkey® (www.surveymonkey.com) was used to administer the
     tial for state rates to be less than that for other required vaccines.  survey, which was emailed to all 440 providers on the list with an
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