WASHINGTON -- Having OB/GYNs provide the tetanus-diphtheria-acellular pertussis (Tdap) vaccine to pregnant Hispanic women can greatly increase vaccination rates in this population, public health researchers reported here.
"This intervention highlighted the fact that [you need to] educate the mom, and more importantly, educate the OB/GYN, because many times the OB/GYNs were not familiar with the latest recommendations on immunization, and then they can't answer the questions the moms may have. Moms often are adverse to any type of immunization, but this is one that would actually help their baby," Diana Ramos, MD, MPH, director of reproductive health at the Los Angeles County Department of Health and a co-author of the study, told MedPage Today in an interview.
Los Angeles County has been dealing with a pertussis outbreak, with 947 cases identified in the region from 2010 to 2015, according to Ramos, who presented the poster here at the National Hispanic Medical Association annual conference. Among babies 0-5 months old, Hispanic children had the highest rate of pertussis infection compared with other ethnic groups during the first 8 months of 2015, at 123.6 per 100,000.
So researchers implemented a 5-month pilot project at a federally qualified health clinic in Canoga Park, a heavily Hispanic section of the county, aimed at increasing Tdap vaccination rates among pregnant women at 27-36 weeks' gestation by 10%. The intervention included:
- Getting buy-in from the clinic staff, including clinic administrators, the obstetrics clinic supervisor, and the immunization clinic supervisor
- Conducting a Tdap in-service for 24 staff members including medical assistants, nurse practitioners, physicians, and nurses
- Encouraging staff to implement standing orders to give the vaccines, in order to eliminate the wait for physician orders, provided the patient is medically eligible and consents to the vaccine
- Linking staff members and patients to educational materials from the CDC and the public health department
- Sending a letter from Ramos to the providers promoting vaccine administration
- Arranging for the clinic to receive the vaccine via the state's vaccine fund
The project was associated with increases in both provider knowledge and immunization rates, the investigators found. Providers' knowledge about Tdap recommendations increased from 77% at baseline (17/22) to 91% (20/22). The Tdap immunization rate in the third trimester increased from 1.9% in January/February (1/52) to 60.1% during March-August, after the interventions (122/203).
"We're now replicating this intervention; it's being taken statewide in California" and looked at nationally as a model, Ramos said.
Several barriers to immunization still remained, however: one was that patients who were in certain managed care plans had to be referred back to their primary care providers to get the vaccine because only they -- not OB/GYNs -- were reimbursed for giving immunizations.
This included patients in managed care plans under Medi-Cal, the state's Medicaid program. "We recently learned from the Centers for Medicare & Medicaid Services (CMS) that the [Medi-Cal] health plans are actually supposed to reimburse the OB/GYNs" for vaccinations, said Ramos. "This is good news for us ... and the hope is the plans will be forced to comply with what CMS says that the regulations should be."
Ramos and co-authors disclosed no relevant relationships with industry.
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