Chicago Department of Public Health National Immunization Conference May 11, 2004 CHICAGO READII Julie Morita, M.D. Medical Director Immunization Program Chicago Department of Public Health

Overview Background Chicago READII Goals Highlights Aldermanic offices role in improving access to vaccines Free vaccine as an incentive for providers to join READII Quality Improvement Initiative

Chicago Population Total  65 years NH White 31% 50% NH African American 36% Hispanic 26% 9%

Chicago Neighborhoods 76 51 25 28 55 61 70 49 30 24 10 56 15 19 71 17 53 23 54 22 69 66 02 46 09 01 12 13 77 11 04 14 03 16 05 06 21 18 20 07 08 26 27 32 29 33 31 34 60 35 59 36 58 38 57 37 39 62 63 40 41 64 68 42 67 65 READII Neighborhoods 43 45 African-American 44 48 47 Hispanic 73 72 50 52 74 75

Immunization Coverage Among Persons > 65 yrs, Chicago Medicare Beneficiary Survey, February-April, 2003

Chicago READII Goals Improve access to immunizations in READII neighborhoods Aldermanic offices Increase providers’ use of effective immunization strategies Vaccine as an incentive Increase minority seniors’ knowledge about influenza and pneumococcal diseases and immunizations Community Outreach Media Campaign

Improving Access to Immunizations, 2003 City of Chicago purchased vaccine Influenza vaccine doses: 50,000 Pneumococcal vaccine doses: 5,000 City-wide distribution: Mass immunization clinics: 150 Private and public clinics: 280

Vaccine Administered in READII Neighborhoods Mass Immunization Clinics: 48 Community based organizations, Park Districts, Senior Housing, Aldermanic Offices Influenza vaccine: 5,480 Pneumococcal vaccine: 850

Aldermen: Chicago’s Legislative Representatives READII neighborhood Aldermen: 23 Participating Aldermanic offices: 11 Mailings, phone calls, flyer distribution Hosted mass immunization clinics Administered doses: Influenza: 1,431 (29% of total) > 65 years: 704 (49%) PPV: 214 (25% of total) > 65 years: 136 (64%)

Lessons Learned, Aldermen Aldermanic offices have access to their constituents > 65 years Mailing lists Phone numbers Offices that contacted their senior constituents had greater senior participation Aldermanic offices may be effective partners in promoting and administering adult immunizations

Future Plans, Aldermen All 23 Aldermanic offices in READII neighborhoods will be encouraged to host and/or publicize clinics Outreach guidance and staff will be provided by READII project Mail and phone notifications, flyer distribution, community meeting presentations

Increasing Providers’ Use of Effective Immunization Strategies Quality Improvement (QI) Approach Illinois Foundation for Quality Health Care Free assessments of office-level immunization coverage Free, ongoing in-office education Standing orders, staff and/or patient reminders, or patient recalls Few providers/clinics interested Lack of access to free adult vaccine identified as primary barrier to immunization

A Novel Incentive: Free Vaccine Recruitment letters Sent to all providers in READII neighborhoods Described QI activities Offered influenza and pneumococcal vaccines as incentive for participation Phone calls Targeted adult providers in READII neighborhoods

Provider Participation Participating clinics: 28 Private clinics: 14 Federally Qualified Health Centers: 14 Clinics receiving CDPH vaccine: 26/28 Most clinics purchased additional vaccine Four clinics received all vaccine from city-purchased vaccine

Vaccine Distribution, Clinics in QI Project Influenza vaccine FQHCs: 2,910 Private clinics: 1,200 No-purchase clinics: 720 Pneumococcal vaccine FQHCs: 1,050 Private clinics: 1,655 No-purchase clinics: 370

Lessons Learned, Free Vaccine Public and private providers perceive the lack of free adult vaccine as a barrier to administration of immunizations Provision of influenza and pneumococcal vaccines was a useful incentive for participation in Chicago’s QI effort Provision of free vaccine may eliminate a barrier to administration of adult immunizations

Future Plans, Free Vaccine Provide free vaccine to clinics in READII neighborhoods Evaluate the impact of free vaccine on immunization coverage Follow-up assessments of office-level immunization coverage Provider survey Strategies implemented Vaccine purchases

Remaining Challenges Different partners and approaches are required for different minority groups Engaging culturally-specific partners to improve access to vaccine Revising immunization messages to be culturally-specific Identifying trusted persons to deliver immunization messages

Acknowledgements African American Health Care Council Chicago Hispanic Health Coalition American Lung Association of Metropolitan Chicago White Crane Wellness Center Cook County Bureau of Health Services Illinois Foundation for Quality Health Care Centers for Medicare and Medicaid Services Region V Office Chicago Department on Aging Chicago Housing Authority