evaluation of immunization delivery services in rural alaska kira m. mori, ba public health...
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Evaluation of Immunization Delivery Services in Rural Alaska
Kira M. Mori, BA Public Health Associate
PHAPOffice for State, Tribal, Local and Territorial Support
Centers for Disease Control and Prevention
2015 PHAP/PHPS Summer SeminarJune 2, 2015
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
Importance of Immunizations
Among children born during 1994–2013 in the U.S., vaccination will prevent an estimated: 322 million illnesses 21 million hospitalizations 732,000 deaths
Estimated vaccination coverage with combined vaccine series among children 19-35 months United States, 2013: 70.4% (±1.5) Alaska, 2013: 63.9% (±6.8)
* http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6334a1.htm?s_cid=mm6334a1_w, http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm
Nome museum, news about diphtheria epidemic that used dog sleds for the ‘1925 serum run’
Alaska: The Last Frontier Largest and most sparsely populated state in the U.S.
2014 population estimate of 736,732 individuals • 40% of Alaska’s population live in Anchorage
o Northern regions may experience winter temperatures reaching below -50 degrees Fahrenheit
o Remote communities are inaccessible by road systems
* www.usmarshals.gov/district/ak/general/information.htm, www.quickfacts.census.gov
Significance to Public Health To improve processes influencing the effectiveness of
immunization delivery services in rural Alaska Harsh terrain, climate, and geography impacting transportability of
immunizations• Immunization delivery is a time sensitive process• Requires multi-faceted practices through the coordination of efforts
Cargo planes used for transporting immunizations from Anchorage to outside facilities
Tribal Hubs Servicing Alaska native
villages with small populations
Tribal hubs order immunizations from depot then redistribute to tribal clinics
Vaccine Depot Alaska is unique in that it
has a centralized depot in Anchorage where pharmaceuticals deliver bulk vaccine
• Operated by the Alaska Department of Health and Social Services
Healthcare providers order select vaccine that is then distributed from the depot to ‘tribal hubs’
Background and Rationale
Walk-in refrigerator used for vaccine storage at depot
Examining shipment of HPV vaccine
*Akchap.org
CHAP Alaska Community Health
Aide Program • Network of community
health aides/practitioners servicing more than 170 rural communities in Alaska
Health care providers serving as vaccine coordinators Vaccine coordinators
located at primary vaccine “hubs”
• Work closely with the state to facilitate immunization delivery processes to tribal hubs from Vaccine depot
Background and Rationale
Methods
Process evaluation Semi-structured, in-depth key informant interviews conducted at nine
tribal health corporations• Traveled to eight remote communities to meet with health care providers
o Utilized a formatted Adobe fillable questionnaire of 40 questions to collect information
o Collected responses identified: current practices, educational training for staff, delivery systems, documentation processes, and barriers to effective immunization delivery
Qualitative Analysis
NVivo Thematically coded
collected data• Data cleaning• Imported responses into
program
Identifying common themes Text frequency
• Word frequency used to evaluate common themes per each question
• Word group queries and text coding used to map word trees and select for word groups
Results All respondents identified six common barriers to effective
immunization delivery services in rural Alaska• Common barriers: Low retention rates of CHAPs, limited accessibility to
resources, limited funding, climatic constraints, lack of knowledge of best practices, and communication barriers between vaccine coordinators and CHAPs
o Three sites identified inconsistent access to electricity and interneto One site identified lack of leadership support
Norton Sound in Nome, AK Samuel Simmons Memorial Hospital in Barrow, AK
Yukon Kuskokwim Health Corporation in Bethel, AK
Implications for Practice
Due to the uniqueness of Alaska, the immunization delivery service infrastructure is incomparable across the nation Results may be used to:
• Improve immunization delivery services in Alaska• Increase access to other healthcare services in remote areas of Alaska
Arctic Ocean in Barrow, AK Barrow neighborhoods
Improving immunization delivery services and increasing access to medical services in remote areas of Alaska
Dillingham Public Health Center in Dillingham, AK
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov/stltpublichealth
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Questions?
Kira M. Mori, BAPublic Health Associate
CDC/OSTLTS/PHAP3601 C Street, Suite 540
Anchorage, AK 99503(907) [email protected]
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support