Project Summary:
This project aims to address the health equity need to overcome influenza vaccine disparities for Black/African American and Hispanic adults and children in southeastern Wisconsin. Since 2019 influenza vaccination rates in Wisconsin residents have fallen significantly from 42% in 2019 to less than 35% in 2023, drastically below the healthy people 2030 goal of 70%. Disparities in vaccination rates highlight an even larger problem as only 26% of Black/African American Wisconsin residents received at least one influenza vaccine in 2023-24 compared to 34% of White residents, and only 26% of Hispanic Wisconsin residents received at least one flu vaccine compared to 35% of non-Hispanic residents. Similar disparities have been seen in the emergency department (ED) population presenting to Children's Wisconsin (CW) (only 28% Black, 41% Hispanic, and 48% White children had received influenza vaccine prior to ED arrival). Addressing disparities in vaccination is a priority in Wisconsin because influenza vaccination has been proven to reduce morbidity and mortality from influenza, and Black and Hispanic adults and children have historically experienced the greatest clinical burden from influenza resulting in higher rates of hospitalizations, intensive care admissions, and death compared to White and non-Hispanic individuals. According to the CDC, such disparities are primarily due to lack of vaccinee access, vaccine hesitancy, and missed opportunities to vaccinate.
To overcome pediatric vaccine disparities, CW has worked to improved vaccine access and address vaccine hesitancy by developing electronic health record (EHR) enhanced workflows to efficiently offer and administer influenza vaccines to pediatric ED patients for the last five years. This program successfully vaccinated 8,500 children during this time (70% with government insurance and 54% represented minority backgrounds). This ED vaccination program has also been shown to be revenue generating. However, CW ED does not currently offer influenza vaccines to parents or siblings of the ED patient.
Prior mixed methods studies suggest that the CW ED represents a missed opportunity to provide influenza vaccines to minority and underserved ED parents and siblings in Wisconsin. Focus groups of Black, Hispanic, and White ED parents identified the ED as a convenient opportunity to vaccinate the entire family regardless of parent race and ethnicity. ED parent surveys demonstrated almost one quarter of low acuity ED patients were accompanied by a sibling and those accompanied by a sibling were more likely to be of Black race and have government insurance. Additionally, 90% of ED patients accompanied by a sibling were unvaccinated, and when offered the influenza vaccine, half of families reported they would accept vaccines for the siblings (parent acceptance rates were not studied). The CW ED annually screens 25,000 patients for influenza vaccine. Assuming 22% of patients are accompanied by at least one sibling and half would accept a vaccine, an additional 2,750 children could potentially be vaccinated each year. Based on historical ED patient demographics, most of the siblings would presumably be from minority backgrounds and would have government insurance. ln 2023, the Children's Wisconsin System-Wide lnfluenza Vaccine Steering Committee set a goal to increase influenza vaccine delivery to all CW patients, siblings, and parents. The goal of this project is to improve influenza vaccine access and vaccine acceptance in minority and underserved adults and children in southeastern Wisconsin. The project team will accomplish this by developing a mobile influenza vaccine clinic in the CW Pediatric ED, where pharmacy students accompanied by a supervisor will counsel, address vaccine hesitancy, and administer influenza vaccines. The target population will be unvaccinated parents and adult caregivers (parents) and siblings (older than six months) accompanying a CW ED patient. ln addition, the project team will partner with the MCW School of Pharmacy to develop an interdisciplinary interprofessional educational clinical rotation for pharmacy students to gain training and hands on experience counseling and administering influenza vaccines to children and adults.
If successful, the CW System-wide Influenza Vaccine Steering Committee intends to spread the parent/sibling vaccine program throughout CW primary care and subspecialty care clinics. In the future, this project has the potential to improve equitable vaccine delivery by establishing the workflow, billing, and staffing model for a mobile clinic that expands the reach of current pediatric vaccine practices and improves delivery to minority and underserved adults and children throughout Wisconsin.
Collaborator: Children's Wisconsin