1. National Immunization Conference May 11, 2004 SAN ANTONIO READII Presented by: Rita Salazar, READII Coordinator San Antonio Metropolitan Health District

2. National Immunization Conference May 11, 2004 Discussion Topics   Bexar County Elderly Profile   Local READII Efforts   Project Highlight: Pharmacists As Public Health Extenders   Additional Interventions   Lessons Learned   Future Plans

3. National Immunization Conference May 11, 2004 PROFILE OF SAN ANTONIO’S ELDERLY POPULATION

4. National Immunization Conference May 11, 2004 Demographics Total Population of San Antonio All Seniors 65+ Anglo Hispanic Male Female 1,425,742 147,746 77,978 58,642 23,606 35,036 Medicare Enrolled Fee-for-service, 2003* Managed Care, 2004** 120,280 76,280 44,000 Influenza Vaccination Coverage Non-Hispanic Hispanic Pneumococcal Vaccination Coverage Non-Hispanic Hispanic 78.6% 65.6% 72% 54.1% Source: Texas State Data Center, 2002 Bexar County Population Estimate based on U.S. 2000 Census Data Source: *Texas Medical Foundation and **San Antonio Secure Horizons Source: Medicare Beneficiary Survey, Feb.-Apr. 2003

5. National Immunization Conference May 11, 2004 Hispanic Population Age 65 and Older, Bexar County Total Hispanic Population 65+ (Bexar County): 55,747 Source: United States 2000 Census Data Elderly Hispanic Residents 5,000 to6,999 4,000 to4,999 2,000 to2,999 1,000 to1,999 0 to999 Downtown MedicalCenter

6. National Immunization Conference May 11, 2004 Influenza Vaccine Coverage of Medicare Beneficiaries, 2001 Rates By Zip Code Total Medicare Hispanic Fee-for-Service Beneficiaries (Bexar County): 27,282 Source: Texas Medical Foundation, 2001 Medicare Claims Fee-for-Service Data 30-39% 20-29% 10-19% 0-9% MedicalCenter Downtown

7. National Immunization Conference May 11, 2004 LOCAL READII EFFORTS

8. National Immunization Conference May 11, 2004 Interventions to Improve Immunization Rates Among Hispanic Seniors  Community Outreach and Education Multi-generational approach Culturally sensitive, multimedia campaign  Provider Education  Service Delivery  Provider Interventions

9. National Immunization Conference May 11, 2004 San Antonio READII Advisory Council  Meets monthly to discuss, plan, and report on READII activities  Four committees formed to aid in the coordination of project activities  Helped in development of Community Action Plan and implementation of project activities  Provide in-kind and indirect monetary support

10. National Immunization Conference May 11, 2004 READII Partners  Alamo Area Council of Governments (AACOG)  City of San Antonio Elderly and Disabled Services  Bexar Area Agency on Aging  Mexican-American Physicians Association  Texas Medical Foundation (QIO)  American Association of Retired Persons (AARP)  Local Pharmacies (HEB, Davila, and Oakdale)  Bexar County Medical Society  Barrio Comprehensive (FQHC)  Aventis Pasteur  Merck, Inc.  Catholic Charities – Archdiocese of San Antonio  Texas Department of Health  University of Texas Health Science Center School of Nursing (San Antonio) and School of Public Health (Houston)  Support of Local Councilmen and State Representatives  Local School Districts

11. National Immunization Conference May 11, 2004 Media Placement Billboards Posters Mobile Advertising - Flu Bug

12. National Immunization Conference May 11, 2004 PHARMACISTS AS PUBLIC HEALTH EXTENDERS

13. National Immunization Conference May 11, 2004 Pharmacists as Public Health Extenders “The San Antonio Model”  Approval by Texas State Board of Pharmacy  Ensure pharmacists possess necessary skills, education, and certification  Ensure administration under a physician’s written protocol  Ensure notification of all vaccinations to ‘sponsoring’ physician (SAMHD)  Participate in continuing education for current immunization standards (CDC, ACIP, etc. )

14. National Immunization Conference May 11, 2004 Pharmacists as Public Health Extenders Traditional Benefits  Accessibility  Cost savings  Extended hours  One stop shopping/convenience  “Medical (pharmacy) home”  Address the needs of mobile population  Repository of information  Spanish-speaking capabilities

15. National Immunization Conference May 11, 2004 Pharmacists as Public Health Extenders Local Family Owned Pharmacy Local Family Owned Pharmacy Chain Store Pharmacy Partners

16. National Immunization Conference May 11, 2004 Pharmacists as Public Health Extenders Future Public Health Partnerships  Disease surveillance/monitoring of dispensed medications  Community crisis planning and response  Extension of preventive care services  Public health and pharmacy training programs

17. National Immunization Conference May 11, 2004 Accountability of Administering Adult Immunizations  Provide Patient Information/ Education (current VIS)  Proper Vaccine Storage and Handling  Maintain Immunization History and Record Keeping  Screen for Contraindications  Adhere to Proper Vaccine Administration

18. National Immunization Conference May 11, 2004 San Antonio Pharmacy Immunization Partner Locations HEB Oakdale Davila

19. National Immunization Conference May 11, 2004 Influenza Doses Administered By Pharmacy Partners 68,10739,72034,79415,581Total 43,98629,29726,63413,088SAMHD 3964600Oakdell 150377160329Davila 23,57510,0008,0002,164HEB '03-'04'02-'03'01-'02'00-'01 Influenza Immunization Season

20. National Immunization Conference May 11, 2004 Challenges/Barriers  Reimbursement issues Medicaid does not provide immunization reimbursement to pharmacists Medicare claims submission can be overwhelming  Processing of consents for entry into registry is time consuming  Difficult to recruit new immunizing pharmacists National chain store and smaller scale pharmacies less receptive to Immunization Model

21. National Immunization Conference May 11, 2004 Additional Interventions  Increasing outreach education and service delivery Engaging faith-based communities Stage community-wide health fairs Immunizing homebound  Assisting providers to capitalize on immunization opportunities Conduct Adult Clinical Assessment Software Application (ACASA) Educate and encourage use of proven effective strategies

22. National Immunization Conference May 11, 2004 Lessons Learned  Media messages need to dispel misconceptions and state the stark consequences of not getting immunized  Need to increase public emphasis on pneumococcal vaccinations  Physicians need more encouragement to offer the immunizations  Pharmacists can help public health focus on the most underserved

23. National Immunization Conference May 11, 2004 Future Plans  Strengthen strategy and efforts to work with providers  Analyze lessons learned through evaluation efforts (i.e. media messages and cost effectiveness of activities)  Share our successes and shortcomings  Increase partnership opportunities and secure additional funding

24. National Immunization Conference May 11, 2004 Rita Salazar Adult Immunization/READII Coordinator, (210) 207-8877, ritam@sanantonio.govitam@sanantonio.gov Sandra Sandobal Adult Immunization Program Supervisor (210) 207-2084, ssandobal@sanantonio.govssandobal@sanantonio.gov Jennifer Ramirez Adult Immunization Program Specialist, (210) 207-8867, jramirez2@sanantonio.gov@sanantonio.govReference www.cdc.gov/nip/publications/adultstrat.htm San Antonio READII Contacts