Improving Access to Immunizations for Indiana Adolescents

The Quality Corner Show chats with Dave McCormick, Director, Immunization Division of the Indiana Department of Health about the Vaccines for Children Program (VFC) and improving access to immunizations for Indiana adolescents.

Podcast Host Nick Dorich asks why this age range is an area for improvement and how pharmacies can make a difference. McCormick explains how pharmacies in Indiana can provide immunizations for children 11 and older and how their expanded hours allows more flexibility for families.

For more information on the VFC program visit https://www.in.gov/health/immunization/vaccines-for-children/

or for quick access to tools on EQUIPP's Knowledge Base
https://support.pharmacyquality.com/hc/en-us/articles/27295877141275-Adolescent-Vaccinations

Chapters

• 0:39 Introduction
• 3:06 Adolescent immunizations as targeted age group
• 6:47 Pharmacy Involvement
• 11:19 What does success for the VFC program look like?
• 14:40 The ask for pharmacists
• 17:40 Closing

Transcript

00:00:01:00 - 00:00:30:08

Dave McCormick

One of the biggest touch points of flu vaccine is pharmacy in the state of Indiana, really nationally, but as you are administering flu vaccines, talk to those clients and see if there are other opportunities to make sure that they are up to date on vaccines. access is just one of the biggest things that we have. and the more access we can create, the more likely you are to get individuals vaccinated.

00:00:30:10 - 00:00:40:24

PQS Voiceover

Welcome to the Pharmacy Quality Solutions Quality Corner Show. Buckle up and put your thinking cap on. The Quality Corner show starts now.

00:00:41:01 - 00:01:01:21

Nick Dorich

Hello, Quality Corner Show listeners, welcome to the PQS podcast where we focus on medication use, quality improvement and how we can utilize pharmacists to improve patient health outcomes. I'm your host, Nick Dorich. Our guest for today's show is Dave McCormick, director, the immunization division at the Indiana Department of Health. Dave, welcome to the show. And how are you today?

00:01:01:23 - 00:01:04:02

Dave McCormick

I'm doing well. Thanks for having me, Nick.

00:01:04:04 - 00:01:19:22

Nick Dorich

Excellent. Well, I'm really excited to have you here. We are a show we talk about as we are a show about pharmacy. But today we're going to be dipping into the public health sector. there is a friend and mentor of mine who has said that all pharmacists are public health practitioners, and I really love that approach to it.

00:01:20:01 - 00:01:30:03

Nick Dorich

We're going to be talking about adolescent immunizations today. But before we do that, Dave, let's hear about you. So, what is it that you do in your role and what is your background in health care?

00:01:30:05 - 00:01:53:17

Dave McCormick

Sure. Well, thanks for that, Nick. again, my name is Dave McCormick. I'm the director of the immunization division at the Indiana Department of Health. I've been in public health for almost 35 years. I started in public health, kind of as, a bridge job. when I got out of college, as I was starting law school, and, really fell in love with public health, actually dropped out of law school.

00:01:53:17 - 00:02:18:10

Dave McCormick

And I've been in this in this field ever since, had a wide variety of experience. I've done everything from housing inspections to, being a training officer. And the last 12 years I've been the immunization division director at the Indiana Department of Health. it's been a very rewarding experience working with immunizations. As you know, that's really one of the frontlines of public health.

00:02:18:12 - 00:02:32:05

Dave McCormick

It's a very, effective, safe way to prevent vaccine preventable disease. And, most people, when you talk about public health, safe water, safe food and immunizations are kind of what come to mind.

00:02:32:07 - 00:03:06:04

Nick Dorich

Yeah, that becomes kind of a holy trio when it comes to public health services or what we can do in our communities. Dave, excited for this conversation today. Excited to have you here. as we discuss adolescent immunization. So, let's get into today's conversation and what we're going to be talking about, is specifically that adolescent immunizations we've seen and for for many years, CDC and other governing bodies have put out other different ideas or goals as it relates to immunizations for different age groups, be it for our elderly population, those over 65, be it for pediatrics, but also for adolescents.

00:03:06:06 - 00:03:33:13

Nick Dorich

You know what we've seen in the last few years, in part because of changes with health care services or availability and accessibility, is that we're not yet meeting our goals for some of those different age groups. For many of those age groups, actually. But for today, we're focusing on adolescent immunization. So from your perspective and from a public health perspective, you know, why are adolescent immunizations, why is this targeted as a particular area for improvement?

00:03:33:15 - 00:03:51:17

Dave McCormick

Yeah. So thanks for that question, Nick. As you mentioned, there are there are a whole life span of immunizations. And people usually think about immunizations. They think of babies, or you think of flu shots, and you don't always think that there's a lot of other vaccines in, in the middle of those. Adolescents are one of those big ones.

00:03:51:18 - 00:04:15:03

Dave McCormick

And so, you know, we want to make sure that our teens are protected as they start different stages in life as they, you know, start high school and then they go off to college. there's some really important things that happen in an adolescent’s life. And so some of those being, you know, they're playing on sports teams, they're doing, camps and different things.

00:04:15:03 - 00:04:37:11

Dave McCormick

And so you have some exposure to illnesses that maybe we hadn't thought of. Meningitis is one of those. And I've heard doctors say that meningitis is one of the scariest things, because it looks like it's a cold, looks like it's a flu. And then in 19 to 24 hours, that child can be, you know, on its way on, on their way to maybe, not surviving that illness.

00:04:37:13 - 00:05:03:02

Dave McCormick

and so, you know, we also think of an adolescent is a very busy, teen. And so they're involved in, like I said, sports camps and different things like that. it's hard to take them out of school to get them to a doctor's office. And so, you know, we really focus on making sure that parents are aware that there are three main vaccines that every adolescent should get.

00:05:03:04 - 00:05:28:03

Dave McCormick

and that being TDAP, HPV, and meningococcal vaccine and making sure that there are plenty of touch points for those vaccines to be administered. Pharmacy is one of those great places, in the state of Indiana, pharmacists can vaccinate down to the age of 11. And so that's perfect for the adolescent platform. you know, HPV, we hope that people are getting that at the age of nine.

00:05:28:05 - 00:05:50:24

Dave McCormick

But if they're not that 11 year old benchmark, you know, kind of as they enter sixth grade is a perfect time to start that vaccine or or complete the series either one. Pharmacy creates a great touchpoint because they're open evenings and weekends, so you don't have to pull a child out of a sports practice or, you know, out of school to make sure that they can go and get those vaccines.

00:05:51:01 - 00:06:08:21

Dave McCormick

The other thing is it sets them up for their adult life. we're making sure that those kids are properly protected so that when they hit college and they and they know, when they're going on to those other ventures in life that they're, they're properly protected.

00:06:08:23 - 00:06:27:01

Nick Dorich

Absolutely. So I think one of the things that I think about the immunizations, right, it's preparing it's prevention. Right. If you're going outside of the country, you're probably going to do a travel health visit with a with a provider. And you may have to get immunizations for diseases like, you know, malaria that may not really be present or expected here in the United States.

00:06:27:06 - 00:06:48:20

Nick Dorich

You know, you may be taking medications as a precaution. Really Dave, summarizing what you're saying here on adolescent immunizations and why some of these immunizations are expected at that time. It really becomes an area where these teens, these preteens, as they're progressing in adulthood and different life experiences that they may have that they're at increased exposure, increased opportunity.

00:06:48:20 - 00:07:11:24

Nick Dorich

Thats there, this is a prime time to be getting these vaccinations as they're going to be set. now, Dave, let's talk about you talked a little bit about this involvement for pharmacy. Let's move to our next question here. And looking at, you know, in, in in Indiana, there's some projects and works being done around, you know, involving, pharmacy for increased access and uptake for adolescent immunizations.

00:07:11:24 - 00:07:24:21

Nick Dorich

So can you tell us a little bit about this? you know, what is kind of expected? You already shared about why pharmacy is a great site for adolescents to receive immunizations, but can you share a little bit of background and, you know, what's expected going forward?

00:07:24:23 - 00:07:49:05

Dave McCormick

So the Indiana Department of Health is committed to increasing access for all vaccines through all life spans. And why? We know that pharmacy is a great touchpoint for and for adult vaccines. we also see that it's a great touchpoint for adolescent vaccines. We know that there are some barriers for pharmacies to join our VFC program or vaccines for children's program, but in Indiana, we're working through those.

00:07:49:11 - 00:08:19:21

Dave McCormick

We're trying to make sure that all pharmacies, regardless if they're a chain pharmacy or an independent pharmacy, can can join the vaccines for children's program and make sure that we have plenty of touchpoints for those kiddos. So right now in the state of Indiana, with the absence of pharmacy being an enrolled in the VFC program, individuals that are Medicaid eligible, uninsured, or underinsured cannot seek, free or reduced cost vaccines at a pharmacy.

00:08:19:21 - 00:08:48:19

Dave McCormick

And we're trying to make sure that we have those touchpoints. So, you know, basically breaking it down. If you are an individual that has private insurance, you have a lot more access to vaccines than those individuals that do not have private insurance. So we're putting a lot of effort in that. We're working with one large chain. We have about 110 pharmacies of this large chain enrolled in VFC, and we've had some great success also with some independent pharmacies.

00:08:48:21 - 00:09:13:12

Dave McCormick

We're hoping that we will continue the success and enroll all of the large change pharmacies so that anybody can go in to any pharmacy, evenings, weekends during the day and receive vaccines for their adolescents. Now again, in the state of Indiana, we can only vaccinate down to the age of 11 in a pharmacy. And we love that model as well, because that creates that medical home for those younger kiddos.

00:09:13:14 - 00:09:33:12

Dave McCormick

And while it's important to have a medical home for the older kiddos as well, we know that scheduling and time makes it more difficult to get them into their medical home. Indiana has a very robust registry, and all of these vaccines go into the registry. So the medical home receives records of all immunizations that are administered in the pharmacy.

00:09:33:14 - 00:09:56:05

Nick Dorich

Excellent update. So, Dave, a couple things I'll note here based on your comments. One, I hear a bit of this that's talking about health equity, making sure that patients, right, regardless of their home, life, work setting but particularly we live in this relates to adolescents that they have access to these important services. the other aspect that you mentioned was that, hey, this is something that can be done in a pharmacy.

00:09:56:07 - 00:10:19:18

Nick Dorich

This is something where, the the patients can be receiving these immunizations outside of normal hours. I'll note that in Indiana, pharmacists are, of course, allowed to administer immunizations. It's also been updates where pharmacy technicians can also provide immunizations in some certain settings and in specific. So this is an area where people have been trained. They've been trained in being able to provide these services,

00:10:19:20 - 00:10:38:14

Nick Dorich

not just as a recent development, but for a number of years. So this is not necessarily something that's new or groundbreaking, but really making it available for the entire spectrum of patients. The final thing that I'll note and what I was, looking up, here in advance of our recording as well, was, well, what is health access like in the state of Indiana?

00:10:38:16 - 00:10:59:11

Nick Dorich

Based upon information from the Indiana Department of Health, roughly a third of the counties in Indiana are considered medically underserved communities, meaning that patients may not readily be able to access primary care or other basic providers. So this is also an area where pharmacies, community pharmacies in particular, they may might be in some areas in some towns or even some of the smaller cities.

00:10:59:11 - 00:11:19:18

Nick Dorich

They might be the best way, the most accessible, or they might be the only health care provider in that setting. So, Dave, you know, for you and the team really looking at this as a, hey, where can patients get the care? That's the important thing is that they have access to the care. Pharmacy is a great setting here, pharmacy teams are trained to provide immunizations and, ready to work with adolescents and their parents.

00:11:19:18 - 00:11:41:05

Nick Dorich

Of course, for having these important conversations. now, with that, I'll move us to our kind of last question for for today. And as we're talking about adolescent immunizations, what does and for and Dave, for, for this project, for the VFC program that you mentioned. What does success look like or how is success defined? Is it you know, it's something where, hey, you.

00:11:41:05 - 00:11:58:20

Nick Dorich

Well, even with immunizations, there are items that may be, you know, reasons for a child not to or an adolescent to not receive a vaccine. So we want to increase the number, but 100% is probably not the goal that we're looking for. But is this about increasing it to a certain rate? Is it about changing perception, changing education?

00:11:58:22 - 00:12:04:24

Nick Dorich

you know, what are goals for the team? And, how would you be evaluating success?

00:12:05:01 - 00:12:26:14

Dave McCormick

That's a really tricky question, right? So in my role, of course I want 100%. Yeah. but even if you look at medical and religious, well, medical exemptions, religious objections, in the state of Indiana, we're only at about 2%. So, you know, we should be looking at high 90s. I think there are a couple things that play into that.

00:12:26:16 - 00:12:46:24

Dave McCormick

one is access, and as you mentioned, you know, it definitely is a health equity issue. I like to tell the story of, my younger son. He was a three sport athlete. and I needed to get him his last HPV shot. And so, you know, to get him his last HPV shot, I would have to take him out of school or miss the sports breakfast.

00:12:47:01 - 00:13:07:16

Dave McCormick

If you missed a sports breakfast and he couldn't play the game the next game. so I took him after soccer practice, 8:30 at night, and if you've ever been around a, kiddo after soccer practice, it's not the most pleasant experience, and so I felt bad for that pharmacist, but we were able to go to a pharmacy, get his last HPV vaccine.

00:13:07:18 - 00:13:32:24

Dave McCormick

But that was only because I had private insurance. And so a medicaid eligible child couldn't do that. So what we're really looking at is making sure that we have access for everyone that wants a vaccine. Now, I recognize vaccines are personal choices. My my recommendation is that everyone, every team should be getting, you know, Tdap, meningococcal, and HPV and but there are also other vaccines, flu, Covid that we should be looking at as well.

00:13:33:01 - 00:13:55:02

Dave McCormick

But making sure those touch points are available, and access is available for all those, those parents and children that need those vaccines and want those vaccines. You asked what would success look like? it recognizing, right. We're not going to be at 100, but if we can get 85 to 90% of all kids vaccinated, then we have what we have herd immunity.

00:13:55:02 - 00:14:23:05

Dave McCormick

And so we shouldn't see a lot of those things circulating in our community. And that's where we really want to be. we we set different benchmarks for vaccination coverage. And, you know, really, those are goals. we want to make sure the vaccines are available so that we have vaccine preventable. So we have, vaccine preventable diseases that are not circulating widely in our in our community.

00:14:23:07 - 00:14:41:10

Nick Dorich

All right. Well, Dave, yeah, goals to reach for. And I'm sure as we as as the program progresses, there'll be either, you know, new updates, new considerations, new challenges that are faced at the same time as well that that may, may come through and may change or adjust what the what the goals for the program are as we learn more.

00:14:41:12 - 00:14:57:00

Nick Dorich

before we wrap here, I do want to ask it, you know, another question for you and or really actually more so provide an opportunity for you to to give some, maybe inspiring words or an ask, you know, to the pharmacist, to the pharmacy community that's listening to the podcast here. what what would be your ask?

00:14:57:00 - 00:15:14:04

Nick Dorich

What would be your recommendation? Or perhaps, you know, the motivation that you can, that you can provide to them as it relates to, you know, becoming involved, becoming a center, becoming a, as you said, kind of a medical home for immunization. What would be specifically your words of wisdom to the pharmacy community?

00:15:14:06 - 00:15:40:06

Dave McCormick

Yeah. So, you know, we're rolling into flu season. So in our area, we hate to think that here we are in August, but we are rolling into flu season. So in the next six weeks we're going to be hitting flu vaccine really hard. And you know, to the to the pharmacy community, what I would say is take this opportunity when you're administering flu vaccine because because we know one of the biggest touchpoints for flu vaccine is, pharmacy in the state of Indiana, really nationally.

00:15:40:08 - 00:16:05:08

Dave McCormick

but as you're administering flu vaccines, talk to those clients and see if there are other opportunities to make sure that they are up to date on vaccines. access is just one of the biggest things that we have. and the more access we can create, the more likely you are to get individuals vaccinated. And so, you know, we know that pharmacy has a lot of foot traffic.

00:16:05:10 - 00:16:35:09

Dave McCormick

And so, you know, really make the most of that. I know I receive vaccines at a pharmacy, just because it's easy and convenient and, you know, the more that we're, we get used to using a pharmacy as a vaccinator, the more just commonplace it's going to be. And, you know, I think it's just a great opportunity for pharmacists to get involved and prove that it's not just going to a pharmacy for, you know, for medicine.

00:16:35:14 - 00:16:41:09

Dave McCormick

It's also for other preventative services. Vaccination being one of those.

00:16:41:11 - 00:17:04:15

Nick Dorich

Yeah, absolutely. It is, Dave, I can I can say my own experience. Part of the my real interest in pharmacy and public health started for myself back in my home state of Rhode Island and pushing for legislative bills that would allow pharmacies to immunize. Now, this was roughly 20 years ago or so. And, you know, from that time now, certainly immunizations have become a standard of practice in the pharmacy setting.

00:17:04:17 - 00:17:22:09

Nick Dorich

And for adolescents or kids today, it's just normal. Or it should be normal that they can receive these services and more, you know, more services coming up in pharmacies as well. So I think that's going to be something that's really a general expectation. And for many like myself, these were things that we learned to do in pharmacy school.

00:17:22:11 - 00:17:40:19

Nick Dorich

And it is more than the dispensing, the medication and the medication process. Pharmacies are a hub for health care services. They are a public health service. And, this is just, I would say to some degree, the tip of the iceberg for what pharmacy can do. so, Dave, that wraps us up for for today. And we appreciate you.

00:17:40:20 - 00:18:00:12

Nick Dorich

We appreciate the Indiana Department of Health for your work and your efforts around involving pharmacists, getting pharmacists engaged and active as it relates to public health efforts. and then also as it relates to how you are improving access, equity and availability, for vaccines, particularly in this adolescent community. now, as we do wrap up, you talked about the VFC program.

00:18:00:12 - 00:18:11:13

Nick Dorich

You talked about some of the things you're doing at the Indiana Department of Health. If folks have a question for you, about these programs or if they'd like to learn more about these programs, is there a best way that they can contact you?

00:18:11:15 - 00:18:37:20

Dave McCormick

Sure. you know, first off, I'm on LinkedIn, so they can always reach reach me through LinkedIn. But we also have a great website at the Indiana Department of Health. And the immunization division has an email address. Immunize@health.IN.gov. Really easy to remember. feel free to to reach out in any venue. that that you're able to and we'll be more than happy to help you.

00:18:37:22 - 00:18:51:09

Dave McCormick

we're always looking for VFC providers. So health care providers, which includes pharmacy. Anyone that's interested reach out to us, and we'd be more than happy to talk with you about that. That and the opportunity to vaccinate Hoosiers.

00:18:51:11 - 00:19:10:13

Nick Dorich

All right, Dave, thank you for that information and for our listening audience. we appreciate you joining the show. Before you go, we'll let you know that you can check out support.pharmacyquality.com and you can check out the knowledge base for more. For more information on immunizations, including and in particular adolescent immunizations, like some of the things that we talked about for today.

00:19:10:15 - 00:19:21:19

Nick Dorich

Now with that, that does mean we have closed this episode and we thank you for joining us. We hope you listen to our next episode of the Quality Corner Show. Before we go, we have one final message from the PQS team.

00:19:21:21 - 00:19:43:11

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00:19:43:13 - 00:20:03:01

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00:20:03:03 - 00:20:05:16

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