Celebrating School-Based Health Centers in February!

February is School-Based Health Center Awareness month, so we are excited to highlight some of the great work they are doing in communities in Oregon.

School-based health centers (SBHCs) are medical clinics that offer primary care services either within or on the grounds of a school. SBHCs provide physical, mental, dental, and preventative health services to children and youth, regardless of their ability to pay. Currently, there are 68 SBHCs located in 20 counties in Oregon. Nine additional communities are planning for new SBHCs, with 8 new centers anticipated to open during the 2014-2015 school year.

Nearly 52,500 school aged children (5-21 years old) currently have access to a SBHC in Oregon. During the 2013-2014 school year, Oregon SBHCs served 23,797 clients in 70,666 visits.  Of these visits:

  • 26% related to a mental health or substance use concern
  • 13% an immunization was administered
  • 13% related to a reproductive health service

SBHCs help get students back to the classroom faster and ready to learn. According to surveyed students who used their SBHC in the 2013-2014 school year, 63% reported they didn’t miss a class while using SBHC services; 77% estimated they would miss one class or more if they had to go to a clinic located elsewhere.

SBHCs also provide quality care and developmentally appropriate services. In the 2013-2014 student survey, 65% of surveyed students reported their overall health was better because of their use of the SBHC; 84% were “very satisfied” with their center.

Want to learn more about SBHCs in Oregon? Visit the SBHC State Program Office website: www.healthoregon.org/sbhc or check out our 2015 SBHC Status Report.

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New Vaccines for Children Program Requirements for 2015

With the New Year come new CDC requirements for the Vaccines for Children (VFC) program. These requirements went into effect January 1, 2015 and will now be assessed during VFC Site Visits or as requested by the Oregon Immunization Program (OIP). The new requirements are as follows:

1.Required training on VFC Program Requirements
All key staff (i.e. Vaccine Coordinator and Back-up Coordinator) must undergo annual training on VFC Program Requirements and training must be documented. This training is currently being developed by OIP. When the training is available, staff will be notified via the VFC list serv. If you would like to be added to the VFC list serv, please email Mimi Luther at lydia.m.luther@state.or.us.

2.Additions to your Vaccine Management Plan
All vaccine plans for routine and emergency vaccine management must include the signature, name, and title of the preparer of the documents. Clinics will be notified when an updated OIP Vaccine Management Guide is available with this change. See example below. In the meantime, please include the required documentation on your current vaccine management plan.

3. Maintain a calibrated back-up thermometer
VFC providers are required to have at least one backup thermometer with a current certificate of calibration on hand (not stored in unit alongside current thermometer). It should be available in case a thermometer in use is no longer working appropriately or calibration testing of the current equipment is required. OIP strongly recommends clinics have a thermometer with a probe in glycol as their primary thermometer; ambient air thermometers are acceptable as a backup. OIP encourages clinics to research options for thermometers that have the option for two year calibration to reduce cost and frequency of calibration. CDC says the backup thermometer should have a different calibration retesting date.

4. Place thermometers in a central location
Thermometers must be placed in a central area of the storage unit with the vaccines. Thermometers should not be placed in the doors, near or against the walls, close to vents, or on the floor of the unit. If you have a thermometer that is currently mounted on the wall of your vaccine storage unit it will need to be relocated to the center to meet this new CDC requirement.

5.Record name/initials and exact time twice-daily
The time and name or initials of the person recording twice daily temperature recordings must be documented with temperature readings. Temperate log templates can be found here: http://www.immunize.org/clinic/storage-handling.asp
CDC recommends that providers using a data logger record the minimum and maximum temperatures once each work day (preferably in the morning).

If you have questions regarding any of the above requirements, or VFC in general, please call
971-673-0300. Thank you for all you do to keep Oregonians well immunized!

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The 2015 Childhood Immunization Schedule is Now Available

from the Centers for Disease Control and Prevention

The 2015 Childhood Immunization Schedule is now available online.  Every year, the Advisory Committee on Immunization Practices (ACIP) develops recommendations for routine use of vaccines in children, adolescents, and adults. When adopted by the CDC Director, they become official CDC/HHS policy.

The Morbidity and Mortality Weekly Report will publish a summary of childhood schedule changes in early February.  However, all of the 2015 figures, footnotes, and tables for the childhood schedule are currently available on the CDC website.

CDC has also updated the following parent-friendly schedules to reflect the new 2015 recommended immunization schedule:

CDC encourages organizations to syndicate content rather than copy a PDF version of the schedule onto their websites to share with visitors. Content syndication allows other organizations’ websites to mirror CDC web content, with automatic updates whenever changes are made on the CDC site. This helps ensure that all schedules are current across the Internet. See how to display the schedules on your site.

The 2015 adult schedule also on the available.

We encourage you to share this information with your colleagues and other interested parties to spread the message about the new schedules.

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Adult Pneumococcal Recommendations in Practice

by Kerry Nolan, Oregon Immunization Program Pharmacy Intern

This is part one of our two part pneumococcal vaccination series. 

Update: This post was edited on 2/5/2015 for clarification.

Situation: A 65 year-old patient has come to our clinic today for a pneumococcal vaccination following her first dose of Pneumovax at age 62.

What vaccination should she receive today? If and when will she need another one? Will it be covered? Since the Advisory Committee on Immunization Practices (ACIP) introduced their latest pneumococcal recommendations for patients 65 and older, both providers and patients have been asking the right questions.

What are the new recommendations?

Adults aged 65 and older should now receive one dose each of Prevnar 13 and Pneumovax 23. Previously, a single dose of Pneumovax 23 alone was recommended for this age group. Although Prevnar 13 has been FDA approved for adults 50 years and over since 2011, it just earned the ACIP recommendation for adults age 65 and up last September. ACIP recommends that adults 19–64 years receive PCV13 if they have an identified health risk.  Healthy individuals age 50–64 may have a dose of Prevnar 13 per FDA approval, however, this dose may not be covered by insurance.  Sounds simple enough, but determining when and who should receive which vaccine gets a bit more complicated. The recommended pneumococcal vaccination schedule separates patients ≥65 years into those who have:
1. Never received any pneumococcal vaccine, and should receive Prevnar 13 first then Pneumovax 23 between 6 to 12 months later
2. Received one (or more) doses of Pneumovax 23, and should receive Prevnar 13 at least one year after their last Pneumovax 23 vaccination
3. Received Pneumovax 23 before turning 65, and should still wait at least one year since their last Pneumovax 23 vaccination to receive Prevnar 13, but must also wait at least 5 years between Pneumovax 23 doses to receive one final dose at ≥65.

In this diagram provided by the ACIP, the latest adult pneumococcal vaccination schedules are summarized:
Pneumococcal vaccine
Image: Sequential administration and recommended intervals for PCV13 and PPSV23 for adults aged ≥65 years — Advisory Committee on Immunization Practices, MMWR 2014

So- which should our patient receive and when? She received a dose of Pneumovax 23 prior to turning 65, which places her in the third category. It has been 3 years since Pneumovax was given, so she should receive Prevnar 13 today. However, when considering the best time for her to return for the final Pneumovax dose, we find that even in 12 months, only a total of four years (not the recommended five) will have passed since her last dose. What should we do? In this situation, the patient should wait the full five years since her Pneumovax dose before receiving the final one. In other words, she will receive Prevnar 13 today and a final Pneumovax 23 dose in about two years.

Will the new vaccine be covered?
On December 31st the Center for Medicaid and Medicare Services (CMS) released a statement announcing that an update to pneumococcal vaccine coverage requirements would be in effect as of September 19, 2014 to align with ACIP recommendations. Effective February 2nd, two pneumococcal vaccines and their administration will be covered under Medicare part B: the first for patients who have never received any pneumococcal vaccine and a second (different) vaccine one year after the first was administered. This coverage is not perfectly aligned with ACIP’s recommendations, but captures where vaccination schedules overlap at the one-year mark. Additionally, Medicare will adjust previously denied claims for qualifying pneumococcal vaccinations administered September 19th or later if the claim is resubmitted. Our patient is more likely to have her second vaccination covered if she is insured privately. As part of the Affordable Care Act, health plans are now required to cover ACIP-recommended vaccines without co-pays or cost-sharing.

As we become comfortable with the nuances of these recommendations, we are better able to provide vaccine protection and education. Tricky timing, different vaccines and varying coverage are each good reasons for giving pneumococcal vaccines in older adults your careful consideration.

References:

1. CDC. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR 2014; 63 (37); 822-825. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm. Accessed 26 Jul 2015.
2. Centers for Medicare & Medicaid Services (CMS). Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations. MLN Matters 2014; p1-3. Available at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9051.pdf. Accessed 26 Jan 2015.

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Program Spotlight: The Oregon Breast and Cervical Cancer Program

January is Cervical Health Awareness month, and we are spotlighting a program at the Oregon Health Authority that works on an issue often related to HPV: cervical cancer.

The Oregon Breast and Cervical Cancer Program (BCCP) helps low-income, uninsured, and medically underserved women Oregonians gain access to lifesaving screening programs for early detection of breast and cervical cancers. Each year, approximately 4,000 people in Oregon receive services through the BCCP.

Since the program began in 1995, 71,509 women have received cancer screening, and 56,780 have received clinical services.  Fifty eight invasive cervical cancers have been detected, and 541 have received pre-cancerous cervical diagnoses.

“The BCCP saves lives through screening, early detection, and referral to treatment,” says Kristin Kane, Manager of the program. “Through this program, we can make sure that Oregonians have access to these essential services, regardless of whether they have insurance that covers these services.”

For program eligibility, visit www.healthoregon.org/bcc

The BCCP follows the United States Prevention Services Task Force (USPSTF) recommendations for cervical cancer screenings, which consist of the Pap test and high-risk HPV testing.  Women between the ages of 21-64 should receive a Pap smear every 3 years. For women ages 30- 64 who want to lengthen the screening interval, they can be screened with a combination of Pap smear and HPV testing every 5 years.

The BCCP is funded by the Centers for Disease Control and Prevention (CDC), Susan G. Komen for the Cure, Oregon and SW Washington Affiliate, and Oregon State general funds. Also, the BCCP partners with the American Cancer Society to run a patient eligibility hotline.

If you would like to learn more about breast and cervical cancer prevention resources in Oregon, please contact our program at 971-673-0581 or visit http://www.heatlhoregon.org/bcc

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Antibiotics and Public Health: A Collaborative Elective for Students and Community

by Tessa Jaqua, AWARE Program Coordinator

Banner

As fall ushered in a change of season, the Oregon AWARE program once again armed itself for the onslaught  of colds, flus, and other viral illnesses that contribute to the overuse of antibiotics in our community. The Oregon Alliance Working for Antibiotic Resistance Education (AWARE) is the state’s coalition whose mission is to encourage the appropriate use of antibiotics and aims to reduce the problem of antibiotic-resistant bacteria in Oregon.

As a statewide coalition, Oregon AWARE takes advantage of the amazing resource and fresh minds from the innumerable educational and community organizations that are committed to the health and wellness of Oregonians. Two of these long time partners are conveniently located right across the river in the AWARE program’s backyard. While the Oregon State University School of Pharmacy and Oregon Health and Science University’s Physician Assistant (PA) program made themselves at home in the new collaborative sciences building on the south Portland waterfront, 15 students from both programs decided to honor the name of their new home by participating in a new collaborative elective course; Antibiotics and Public Health.

These pioneering students spent 10 weeks learning about the effects of antibiotic resistance globally and locally, the benefits of judicious antibiotic use, preventive vaccinations, and educational techniques for reducing overuse to preserve this life-saving resource. Each topic was presented with consideration and professional feedback from PAs, pharmacists, and immunization and antibiotic resistance educators.

Students were charged with completing not only lessons and projects,  but also organizing and running the Oregon AWARE program’s annual Get Smart About Antibiotics Week event, AWARE on the Square. Students organized everything from volunteering, logistics and vaccination provision, to media and community outreach for this event in Portland’s Pioneer Square. Working in interdisciplinary groups to maximize efficiency and promote participation from fellow students, these students assured that the event was a rousing success. Students educated or surveyed over 725 Oregonians and provided no cost flu shots to 46 uninsured/underinsured adults.

At the end of the term, students reflected on the course with positivity and excitement at getting to work with students from other programs and disciplines. They credited their success on final projects and AWARE on the Square to having varied and unique input from their fellow students and instructors. Many hope to carry interdisciplinary cooperation into other areas of their programs.

Oregon AWARE, the OSU School of Pharmacy, and OHSU PA program are pleased with the student’s success and the service they were able to provide to the community through events and student projects.  The programs hope to continue the elective in the fall of 2016 and plan to expand registration up to graduate nursing and medical students as well.

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HPV: Same Way, Same Day

Source: CDC Preteen Vaccines

Did you know that the female Hispanic patients in your practice have a greater chance of developing cervical cancer later in life than non-Hispanic patients? United States Cancer Statistics on cancer incidence show Hispanic women have the highest rates of cervical cancer in the United States. You can reduce this disparity and protect your patients’ future health with HPV vaccination.

You are the key to cancer prevention. Research shows that an effective recommendation from a healthcare professional is crucial to a parent’s decision to get the HPV vaccine for their child. One way to make an effective recommendation is to recommend all routine adolescent vaccines—Tdap, meningococcal, and HPV—at the same time without singling out HPV vaccine or presenting the vaccine as optional. If parents ask why HPV vaccination is needed, remind them that HPV vaccine is for cancer prevention.

Prevention is easier than treatment. More than 4,000 women die of cervical cancer every year, even with screening and treatment. Over 27,000 men and women in the U.S. are diagnosed with a cancer caused by HPV every year—that’s a new case every 20 minutes! HPV vaccine could prevent the majority of these cancers from ever developing, but only 57 percent of adolescent girls and 35 percent of adolescent boys have received the first dose, according to the most recent data from the Centers for Disease Control and Prevention (CDC). . In comparison, 86% of teens have received Tdap and 78% have received meningococcal vaccines.

Recommend HPV vaccine the same way and the same day you recommend the Tdap and meningococcal conjugate vaccines. For example, start your vaccine discussion with the parents of preteen patients by saying: “Your child needs three shots today—meningococcal, HPV, and Tdap vaccines.”

For more information on having successful conversations with parents about HPV vaccination, and to learn how to answer common questions, download CDC’s Tips and Timesavers factsheet at www.cdc.gov/vaccines/YouAreTheKey. This site also has patient education materials in Spanish that your staff can download and print for the parents of your Hispanic patients.

If parents have concerns about paying for vaccines, the Vaccines for Children (VFC) program may be able to assist. The VFC program provides vaccines for children ages 18 years and younger who are uninsured, Medicaid-eligible, and/or American Indian or Alaska Native. Send parents to www.cdc.gov/Features/VFCprogram/ to learn more about the VFC program.

You can find out more about the Oregon VFC Program by clicking here.

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