Category Archives: Private Clinics

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Why We Care About HPV

By Isabel Stock, Colorado State University

Oregon Immunization Program Intern

The idea immunizing your child to prevent a sexually transmitted infection may seem foreign to many parents. People across the world have different views regarding vaccination, but all can agree on cancer prevention. It is our duty as public health advocators, medical professionals and community stakeholders to promote the importance of the HPV vaccination. Here are some astounding numbers to show the impact Human Papilloma Virus has compared to other diseases that we commonly vaccinate children for:

  • 1,904 polio deaths in the U.S. in 1950 (near the height of the epidemic)
  • 450 measles deaths every year in the U.S. before the vaccine
  • 500 tetanus deaths every year before widespread use of the vaccine in the U.S.
  • 100 chickenpox deaths every year in the U.S. before introduction of the vaccine
  • 4,000 HPV-related cervical cancer deaths in the U.S. every year

With 12,000 women being diagnosed every year with cervical cancer, it’s noteworthy that 1 in 3 of them do not survive for five years, especially when the HPV vaccination and screening can prevent up to 93% of these cancers. Other than the cervix, HPV is associated with cancer of the anus, vulva, vagina, oropharynx and cervix in women and HPV related cancers in men are found in the anus, oropharynx and penis.

With 79 million people in the U.S. currently infected with HPV, 14 million new infections every year, the National Cancer Institute has released a Call to Action. In the U.S. 40% of females and 21% of males are receiving all three doses of the HPV vaccine. In Oregon, 36.4% of females and 20.6% of males are receiving all three doses of the HPV vaccine. It is clear that the U.S. will fail to meet the Healthy People 2020 goal of 80% HPV vaccination rate for all three doses. We are faced with a significant public health threat if we don’t take immediate action to improving our vaccination rates.

Here are the best ways to begin improving HPV rates in your clinic today:

  • Know how to frame your conversation regarding HPV with parents and provide them with educational resources
  • Start the vaccine on time; schedule wellness visits at age 11 and 12
  • Schedule follow-up visits before they leave the office
  • Practice reminder/recall for 2nd and 3rd doses
  • Provide walk-in or immunization only visits
  • Immunize at sports physicals

For more information on how to implement these actions, go to: https://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/ImmunizationProviderResources/vfc/Documents/AFIXQIActionSteps.pdf
HPV kids

References:

https://karenvaxblog.wordpress.com/2016/01/14/im-pro-vaccine-but-that-hpv-vaccine/

http://www.cdc.gov/hpv/parents/vaccine.html

https://www.mdanderson.org/content/dam/mdanderson/documents/prevention-and-screening/NCI_HPV_Consensus_Statement_012716.pdf

www.cdc.gov/vaccines/teens

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Framing the HPV Conversation

By Isabel Stock, Colorado State University

Oregon Immunization Program Intern

Many parents who choose to vaccinate their children are faced with the worry, “Do I vaccinate my child for Human papillomavirus?” According to the 2012 National Teen Immunization Survey, one of the main reason parents that didn’t intend to vaccinate their children against HPV was a lack of healthcare provider recommendation. It’s time to frame the conversation between parents and providers on the importance of the HPV vaccination.

As a provider, it is important to recommend HPV vaccine as you would any other, especially on the same visit as other vaccinations. Here is a list of other important factors to highlight when discussing the HPV vaccine with parents:

  • It is one of the only vaccines available to prevent cancer.
  • HPV infection can be passed through any type of sexual activity, not just intercourse. Some types of HPV are spread by skin-to-skin contact.
  • Multiple research studies have shown that HPV vaccine does not make kids more likely to be sexually active.
  • HPV vaccine has a strong safety record. More than 62 million doses have been given in the United States, and there are no serious safety concerns.
  • Put HPV first when listing the vaccines that the child needs during the visit. For example, “Your child needs three shots today: HPV vaccine, meningococcal vaccine and Tdap vaccine.”
  • Vaccinate for HPV well before children might be exposed to it, just as you would for other diseases such as measles.
  • Emphasize your personal belief in the HPV vaccine, and let them know that you have given it to your son/daughter/family member/friend. This is a powerful tool to help parents feel more secure about their decision

All of these tips will help educate the parent to make a decision and avoid missed opportunities to increase HPV vaccination rates. There are many more resources available to frame the conversation between providers and parents on the CDC website. Below is a great resource for providers to start.

         HPV Tips FINAL

When talking with vaccine hesitant parents, it is helpful to use a communication approach that guides rather than directs and encourages the parent to ask questions. Engaging with good communication strategies allows parents to come to a decision on their own, using evidence based facts delivered by the provider. This technique has been shown to help families and providers address concerns in a way that allows the provider to convey respect and empathy while sharing medical information. For more information on effective communication strategies see, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480952/.

To help parents understand just how safe, effective, and necessary this vaccine is for their children check out the National Cancer Institute’s recent Call to Action at, https://www.mdanderson.org/content/dam/mdanderson/documents/prevention-and-screening/NCI_HPV_Consensus_Statement_012716.pdf. Now, more than ever, it is important we give parents all the necessary facts about HPV vaccination to give their child the best possible chance to live a cancer free life.

References:

http://www.cdc.gov/hpv/hcp/index.html

http://www.cdc.gov/hpv/hcp/answering-questions.html

http://www.cdc.gov/hpv/hcp/speaking-colleagues.html

http://www.cdc.gov/vaccines/who/teens/vaccines/vaccine-safety.pdf

https://www.mdanderson.org/content/dam/mdanderson/documents/prevention-and-screening/NCI_HPV_Consensus_Statement_012716.pdf

http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-11-74

 

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We Can Prevent Cervical Cancer

By Katherine McGuiness, MPH, MSW

ScreenWise Engagement and Eligibility Coordinator, Oregon Health Authority

January is Cervical Health Awareness month, which is a great time to reflect on the fact that most cases of cervical cancer are preventable.  The two main ways we have of preventing cervical cancer are through the HPV (human papillomavirus) vaccine and cervical cancer screenings like pap smears and HPV co-testing and subsequent treatment.

 HPV

HPV Vaccine

The new Gardasil vaccine protects against the 9 of the most common HPV strains, many of which are found in a variety of cancers, including 90% of cervical cancers. The vaccine can be given between the ages of 9 and 26, with a preference of getting it earlier than later in age. Getting the HPV vaccine early is one of the best ways to prevent cervical cancer.

Cervical Cancer Screenings

Pap tests and HPV tests are screening tests that help prevent cervical cancer, or find it early. The HPV test looks for the virus that causes most cervical cancers. Currently, the HPV test is recommended for those over 30. The Pap test looks for precancers- like changes in cells on the cervix that can turn into cancer if they are not treated. National guidelines suggest that pap testing is recommended for people aged 21-65 with a cervix.

For people who have insurance, most insurance plans cover the cost of cervical cancer screenings. For those that do not have insurance, Oregon’s ScreenWise Program may be able to cover the cost. ScreenWise covers the cost of breast and cervical cancer screenings for people who live in Oregon, are uninsured, and meet certain income criteria. There are ScreenWise clinics all over the Oregon. To find out more about eligibility and clinic locations, call 1-877-255-7070.

Are you interested in having your clinic provide ScreenWise services?

Contact Katherine McGuiness at (971)673-0343 or Katherine.h.mcguiness@state.or.us

Sources:

http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil-9.html

http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening

http://www.nccc-online.org/images/pdfs/HPV_fact_sheet_2015.pdf

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Children’s Clinic takes an extra step to protect newborns

The CDC recommends that everyone over the age of 6 months get immunized for influenza. But what about newborns who are too young to get vaccinated? Providers at The Children’s Clinic, a century-old Portland-metro area pediatric practice, are looking for a way to take care of those infants. “The most vulnerable children are too young to be vaccinated, so we looked for another way to protect them,” says Heather O’Leary, RN, BSN, Manager of Clinical Services at The Children’s Clinic. Their solution is to immunize the parents and caregivers of newborns by making flu vaccines available at the infant’s newborn – 4 month visits. The challenge is how to handle immunizing adults within the constraints of a pediatric practice.

Vaccines for Children can provide immunizations for parents and caregivers who are younger than 19 and uninsured, Medicaid, or American Indian/Alaskan Native. But Phyllis Layton, The Children’s Clinic’s Purchasing Coordinator says “We are still working on the billing part as we are not their primary care provider.  However, we feel that if pharmacies can do it, we can too.”

The Children’s Clinic has 24 pediatricians and one pediatric nurse practitioner who work at two sites:  one in Southwest Portland near Providence St. Vincent Medical Center and another in Tualatin, near Legacy Meridian Park Hospital. Last year they provided about 14,000 flu shots to children. This year, they hope to protect even more kids by making sure their parents and caregivers don’t give them the flu.

 

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Vaccine Emergency Plans: Details to Consider

When it comes to storing vaccine, expect the unexpected. The Oregon Immunization Program requires that your clinic create an emergency plan:  a document that describes, in detail, the process for relocating vaccine in case of an emergency such as a natural disaster, equipment malfunction or other event.

The emergency plan should be written for your clinic specifically. If your clinic belongs to an umbrella organization, it is not acceptable to rely on one plan for the entire organization. An  emergency plan is most  useful when it takes into account a clinic’s location, equipment, etc. It’s also important that an emergency plan be written clearly and in great detail so a person who is not trained in vaccine management can successfully follow its instructions. This is critical since, in the case of an emergency like a snow storm, the first staff person able to reach the clinic may not be familiar with handling vaccine. The plan should be easily accessible to all staff and all staff members should be aware of its location. Your emergency plan needs to be reviewed by all relevant staff members and dated annually.

A complete emergency plan should have:

  • instructions on how to check the temperature of the vaccine
  • the correct temperature range for the vaccine
  • instructions on packing the vaccine
  • the location of vaccine packing material in your clinic
  • the phone numbers of the primary and secondary contact people for the emergency vaccine storage location
  • directions to the emergency vaccine storage location
  • phone numbers of your clinic’s vaccine coordinator and back-up
  • phone numbers for your clinic’s utility company, etc.
  • the phone number of the Oregon Immunization Program*

 *We will help you determine the viability of the vaccine if the temperatures have gone out of range. We also must be informed when the vaccine is being, or has been, moved to the emergency location.

 

 

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EOC Staff Transition

Enhanced Ordering Cycle (EOC) is a process that balances clinic vaccine order sizes, order frequencies, and storage and handling costs to improve work flow and reduce costs.  The Oregon EOC Team has appreciated the ongoing efforts made by clinics that have implemented the process over the past year and a half. A total of 178 clinics were targeted and trained in EOC.  This training phase of EOC will be ending in June 2011. 

 As the Oregon EOC Team transitions to other duties within the Immunization Program, there will be some changes to the EOC process that clinics should take note of.

  •  Starting in June, all questions related to your assigned ordering cycle should be directed to your clinic’s VFC Health Educator. 
  •  All VFC orders will continue to be tracked and assessed by state VFC staff to ensure that clinics are adhering to their assigned cycle and ordering windows.

 The EOC Team is pleased to report that participation in EOC has contributed to a 30% reduction in orders placed by the targeted clinics. Of all the orders placed by targeted clinics, 78% have been within the recommended ordering frequency and nearly 70% have been within assigned ordering windows. Because of these positive trends, the Oregon EOC Team is confident that clinics will continue to place on-cycle orders by following their ordering calendars and staying on top of their vaccine inventory quantities. 

 By the end of this year, all remaining clinics that were not included in the targeted group of 178 will also be assigned a new ordering cycle. Notification and guidance regarding new ordering cycles will be sent to all remaining clinics by mail. Clinics with questions regarding order assignments can contact their VFC Health Educator.

 

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Flu vaccine: let’s use it until we lose it!

By Kate Parker-Shames, VFC Health Educator
 

It’s the end of flu season. Often it seems like a lost cause, vaccinating patients against flu at this time of year. Many clinics around the state have a small amount of short-dated flu vaccine in their refrigerator, and in some clinics, that vaccine will just fill space until they expire.  It is still possible to administer flu vaccine, even this late in the season! Last week, while on a visit to Samaritan Pediatrics, I was reminded of how we should still encourage families to get immunized for flu- even though it is late in the season. When I asked the clinic how they were doing getting through their short-dated flu stock, I was told that the clinic was having no problem using up their flu stock; as they were still immunizing for flu. While the clinic’s rate of administering flu vaccine had slowed down a little since the winter months, they were still giving quite a few doses per day. The clinic told me that they thought they would probably use all their doses before the end of the month. Wow, I thought, I wonder how they do this. So many of our providers around the state have difficulty getting flu vaccines into patients this late in the season; so, how does this clinic do it?

My curiosity piqued, I asked clinic staff, and they told me:

Clinic staff said that it was almost a non-issue for them. Their attitude towards administering flu vaccine is straightforward:  it is still flu season, we have flu vaccine available, and anyone who is eligible should get the vaccine. Any eligible patient who sets foot in their clinic should get flu vaccine. 

First reason: children should get the flu vaccine every year. If they have not gotten their vaccine for this flu season, they should get it. The clinic screens every kid who comes to the clinic to see if they have yet received their flu vaccine for this season. Just because flu season is ending doesn’t mean that, (1) a kid can’t still get the flu, or (2) that they shouldn’t have access to the long-term immunity against this year’s flu strain for protection in future flu seasons. 

Second reason: a lot of pediatric patients require two doses of flu (children under 9 years old getting flu vaccine for the first time should have two doses in their first season of being immunized), so every kiddo fitting this category is screened when they come to the clinic to see if they have had their second dose of the season, and if they haven’t had their second dose already this year, they get it….even in June. 

Keys to successful late-season flu vaccine administration:

Attitude: the clinic treats late season immunization as a non-issue. People need the flu vaccine, should get it, and therefore, the clinic offers it whenever patients are eligible. 

Screening: the clinic is screening every patient who comes into their office to see if they are due for a flu vaccine

We can all learn a little from Samaritan Pediatrics! Let’s use these last few days of flu season 2010/11: screen all patients who walk through your doors for flu eligibility. Let’s use these flu doses before we lose them!

 

 

 

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