Immaturity .

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Lacking information - Most wellbeing and inoculation information concentrates on kids 0-3 ... School based wellbeing facilities - Proven substances with wide bolster; high enlistment of teenagers. ...
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Pre-adulthood – A Challenging Time to Promote Prevention and Immunization Juan Carlos Batlle, MD \'04 University of Pennsylvania School of Medicine Thomas K. Zink, MD GlaxoSmithKline, Immunization Policy and Scientific Affairs

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Adolescence: A Hidden Opportunity

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Adolescence: A Hidden Opportunity 41 million young people matured 10-19 Age bunch a pot for high-hazard conduct 45% of secondary school understudies have had intercourse 10% have attempted cocaine Older teenagers not getting to human services ~20% have inevitable required consideration in the previous year ~20% have no protection or therapeutic home One study puts expense of preventable juvenile morbidities at $700 billion/year ( Adolescent Medicine: StARs . 1999;10(1):131-151.)

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Adolescent Immunity (Or Lack Thereof) Vaccination rates range from 20-90% 35 mm adolescents 11-21 missing no less than one antibody Late 80s/Early 90s: 47% of measles cases were among youths/youthful grown-ups Adolescents speak to 70% of the 100-140K cases/year of hepatitis B and 29% of all pertussis cases Handal G. Pre-adult inoculation. Immature Medicine: State of the Art Reviews . 2000;11(2):439-452.; MMWR 2002; 51: 73-76.

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Challenges to an Adolescent Approach Age bunch variability - Adolescents are a moving target, matured some place somewhere around 6 and 21 Physicians intense to target - Adolescents are not the elite region of any MD Deficient information - Most wellbeing and inoculation information concentrates on kids 0-3 Lack of a therapeutic focusing on model - Few items recommended principally to youngsters

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Teens Engage In Risky Behaviors YRBS: CDC-led national school-based review of 13,601 understudies in evaluations 9-12 amid Feb-Dec 2001. 46% had ever had intercourse (61% of blacks). 7% engaged in sexual relations before age 13 (16% of blacks). 33% of understudies engaged in sexual relations inside 3 mos. of review. 42% had not utilized a condom finally intercourse. 870,000 pregnancies/year among 15-19 year olds. 3mm STDs among 10-19 year olds. Youth hazard conduct reconnaissance - United States, 2001. Grimness & Mortality Weekly Report. Observation Summaries . 51(4):1-62, 2002 Jun 28.

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Health Care "Hazard" Also Increases 1999 Add Health Study: 12,105 young people (grades 7-12), 1994-95 school year. 18.7% had predestined consideration in the previous year. 13.0% of youngsters had no protection and another 6.5% had intruded on protection. Uninsured high schoolers were destined to forego care (23.9%). 33.0% of all adolescents had no physical exam in the previous year. Passage CA. Bearman PS. Ill humored J. Inescapable human services among teenagers. JAMA . 282(23):2227-2234, 1999 Dec 15.

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How Adolescents Are Addressed By Health Care

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No protection 15% Alternative Site 10% * 25% Don\'t Public protection 20% 15% Don\'t Private protection 65% 17% Don\'t Other 1° 20-25% ** FP 20-25% Peds 20-25% E.R. 20-25% 80% Access Care 20% Don\'t The Teen Health Care Universe 65-70 million visits/yr *Includes School Health Centers, Family Planning Clinics **Includes OB/GYN, Internal Medicine, Hospital Outpatient Source: JAMA 1999;282(23): 2227-34.; NAMCS

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Physician Change Fragments Care NAMCS Office Visit Data

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Health Care Guidance Slowly Rising In 1995, ACIP prescribed make up for lost time Hep B of all kids 10-12 at "early youthful visit" In 1996, proficient social orders join (AMA, AAFP, AAP) with ACIP to advance anticipation arranged early immature visit Guidelines show up (Bright Futures, GAPS) 2004 Childhood Immunization Schedule incorporates a preadolescent visit

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Adolescent Vaccines On The Way

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Adolescent Vaccines On The Way NIAID: The Jordan Report 2002.

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Messaging Is Missing For children <15, half of visits for an intense issue; 27% for non-sickness care. In 63% of visits, no remedial or preventive administrations were requested or gave. HIV/STD transmission examined in 0.6% of visits. (Directing regularly on eating regimen, 15.0% of visits). However 86% of adolescents 15-17 appraised sexual wellbeing a "major individual concern" and the most astounding evaluated concern in general. Source: NAMCS 2000 information. Propel No. 328.; Kaiser Family Foundation National Survey of Adolescents and Young Adults 2003.

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Getting Vaccines Into Teens

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Immunization registries Physician training Improved protection Improved access to care Middle school commands Patient instruction Tracking/effort Incentive projects Passive: Attempt to "catch" patients. Dynamic: Influence patients to request inoculation. "Inactive Teen" versus "Dynamic Teen" Strategies

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Passive Strategy: Catch the Teens School based wellbeing centers - Proven substances with wide bolster; high enlistment of adolescents. Work related endeavors - Employer motivating forces to work in paid time for the lowest pay permitted by law representatives to look for medicinal services. Portable center - Access under-served or divided zones. Shows, shopping centers, and so forth. Shopping center stands - Low cost, secret facilities to direct regenerative wellbeing administrations, vaccinations, minor intense consideration.

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Active Strategy: Quid Pro Quo School section necessities - Proof of vaccination at a specific evaluation level. Sports support/Camp interest prerequisites Motor voter sort exertion - Require inoculation for driver\'s permit or SAT exam. Tattoo/body penetrating - Policy necessity of verification of inoculation.

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Thought Experiment: Churn Rate 4 mm new 10 year olds every year – how would we get them before they are 14? Accept 30% are inoculated every year 1.2 mm vaccinated every year, then? No issue inoculating each of the 4mm by 14. Yet, a few children never present to the framework Churn rate gets to be essential Need to enhance % of children recently showing to framework, "stirring" in the unimmunized

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Takeaways At 30% yearly rate, whole companion is effectively gotten in the event that all teenagers introduced to framework. # of years of make up for lost time is altered. Stir rate is urgent: Increasing high schoolers new to framework to 58.3% yields 0.7mm incremental catchup every year and no lost adolescents The Churn Factor New 10 yr olds 4mm Imm. rate (4mmx30%) - 1.2mm Churn Rate 58.3% Incremental addition/yr - 0.7mm (- 4mmx58.3%x30%) Years of get up to speed 4yrs Incremental Catchup (- 0.7mmx4yrs) - 2.8mm Lost 10 year olds 0 Getting Teens Into System Is Key

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Alternative Care Sites Simulate Churn Clinics get high schoolers outside the conventional patient-specialist relationship School-based wellbeing focuses Planned Parenthood/Teen facilities HMO-based centers Immunization programs likewise get adolescents Motor/voter sort drives Canvassing effort "Inoculate Before You Graduate" 70%+ of doctors concur that option care destinations are worthy for vaccination.

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Other Tools Effective At Churn CHIP Enrollment: CHIP youngsters were 85.6% UTD on at 24 months contrasted with 54% of non-CHIP Tracking/Outreach: Increased mean wellbeing visits by 0.44/kid/yr; raised inoculation rate 20 % focuses. Data frameworks: AFIX, utilizing CASA framework, expanded inoculation rate by 10 % focuses in 1 year in Maine. Vaccination drives: Baton Rouge drive inoculated 5000 high schoolers in 5 years with minimal budgetary backing; GET HEP B in Missouri. Pediatrics 2002;110: 940-945. ,Pediatrics 1999;103:31-38., Pediatrics. 1999; 103:1218-1223., Ped Inf Disease Journal . 1998;17(7 Suppl):S43-6.

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The "Pre-Adolescent Visit"

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F I N I SH L I NE? Swarmed plan … until 24 months 0-24 months = "shots" 4-6 years = "supporters" 10-12 years = "not my child"

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Hep B infection detached 1967 Hep B vax accessible 1981 ACIP reco all inclusive 1991 Kid scope hits 90% 2001 Hep B Vaccine As A Model "High-chance"- situated STD, not generally repaid ACIP proposal starts development, but rather development not uniform after some time. Boosting development: repayment, commands, general wellbeing activities, extra recos. Lesson: progress has been moderate...

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STOP FAST SLOW Hep B Immunization, Kids 19-35mos. ACIP Birth measurement reco Oct 01 ACIP Reco Nov 91 CDC/NHIS Healthy People 2000 & 2010 Database;

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Expanding Physician Involvement Family Physicians 33% to half of pre-adult visits made to FP Emergency Physicians 25% of pre-adult visits to ER (13mm visits) OB/GYNs Reach all ladies Represent 40%-half of all female high schooler visits Ramifications Insurance scope; new CPT codes Patient/guardian/supplier states of mind

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Milestone Prevention Visits As A Tool Pre-juvenile visit at age 10-12 Recommended visits at age 5, 10, 15, 20?

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Questions? … Thank you!

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