Good afternoon, everyone. I'm Beth Baker, and I'm going to be the moderator for the next two sessions. And I'm also chair of the ACOM Physician Advisory Workgroup for the CMSS and CDC Collaborative Agreement, and we're going to be talking about best practices to increase vaccination rates among workers. These are the old slides. I have no disclosures, and turns out, the new slides, the only person, speaker who had disclosures was Dr. Bresnik, who has some shares of Moderna. We also included, I think this was the main change. We also have the usual CDC disclaimer, because it's partially funded by CDC, in part, that our views do not represent the CDC or the federal government. So ACOM was lucky enough to be selected as one of seven partner societies to partner with the Council of Medical Specialty Societies and CDC in a collaborative agreement in 2021. ACOM's particular mission was to increase COVID-19 influenza and routine adult vaccination rates among adults in occupational settings, particularly those with high health risk, through education, dissemination, and quality improvement initiatives. And actually, CDC told CMSS we needed to be included because we have access to the workers. These are the other stakeholders. They're mainly subspecialty societies under CMSS, in addition as us. And the recommendations are based on the CDC Standards for Adult Immunization Practice that you can find on their website. They recommend we assess immunization status for all our patients at every visit, and strongly recommend vaccines that patients need. And you can either administer the vaccines or refer them to a vaccine provider that can provide them. And if you give vaccines, document the vaccines that you give your patients. ACOM's role is to partner with seven to 10 healthcare systems to develop, promote, and implement quality improvement interventions to increase adult vaccination in their clinics. And initially, they need to conduct a vaccine assessment, assessment of their vaccine processes and deliveries, processes, and then determine their baseline immunization rates among adults in their clinics. They then are supposed to implement a quality improvement intervention and conduct monthly assessments and measure change, and also address challenges and barriers to vaccine hesitancy and confidence. And lastly, to disseminate the findings through manuscripts, conferences, and newsletters. Are you changing the volume? Okay. CMSS is who we're contracted with, and then they're contracted with CDC. CMSS intends to develop and update vaccine guidance, policy statements, and standards regarding implementation of these CDC standards for adult immunization practice. They're going to develop and promote continuing education on adult immunizations for all members, train and maintain immunization champions to promote outreach and improve educational needs, disseminate best practices, outcomes, and lessons learned to CDC and the specialty societies, and develop a more systematized approach to adult immunizations. And ACOM needs to recruit at least one, if not two, more additional partners. And we have another round of applications that are due on June 16th of this year, 2023. And we may have a round after that, depending on how many groups we have that are applying. And the intent was to get a variety of different occupational medicine practices. As you know, occupational medicine practice can be very different from one clinic to another. These are our current partners, Health Partners Institute and Dr. Zeke McKinney, University of California, San Diego, Dr. Marcia Ishikara, 3M, Dr. Karen Leniak, Albertson's Companies, Dr. Rajiv Das, Fradent Health, Dr. Laura Radke, and Arkansas Occupational Medicine Services Doing Businesses as Conservative Care Occupational Health, Dr. Konstantin Bresniff. And we've had some publications already and had a variety of activities. So we've done publications on travelers' health and vaccinations, statement on adult immunizations, monkeypox guidance, and a vaccine-specific podcast, including vaccine side effects and vaccine hesitancy, violent boosters, flu season, and monkeypox. We sponsored a day of adult vaccine lectures at the Virtual Fall Summit in 2022. We've done virtual focus groups and had vaccine champion training. And these are all available. On our website, this is the website. And if you have questions, please contact Julie Orting or Isabel Montoya-Curtis or visit the ACOM membership booth. And first up is Dr. Karen Leniak. And let's get her slides up. There we go. Thank you. Hello. I'm Dr. Karen Leniak. I work at 3M. We're going to go through the best practices to increase vaccination rates among workers at 3M. And we were very pleased and excited to receive this initiative. I am trying to use this mouse to maximize the slides. I'm sorry. I'm trying to use this mouse to maximize the slides. I'm sorry. I'm trying to use this mouse to maximize the slides. I'm sorry. I'm trying to use this mouse to maximize the slides. I'm sorry. I'm trying to use this mouse to maximize the slides. I'm sorry. I'm trying to use this mouse to maximize the slides. I'm sorry. I'm trying to use this mouse to maximize the slides. I'm sorry. I'm trying to use this mouse to maximize the slides. I'm sorry. I'm trying to use this mouse to maximize the slides. I'm sorry. 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So we've been very fortunate with the two sites that we have this year, very on board with ideas and had great feedback to make it work better for them. We're enhancing our documentation methods, we're developing our online module that was also very exciting. We thought with manufacturing, we would really need to do all in-person sessions, but with a 90% participation rate at our pilot sites on their online COVID survey, we were really able to capitalize on that, make our questionnaire online, and then create a 3M Learn module that people can log into on their own time and then receive an incentive for completing it. So that's very exciting and that's going to be very factual and those group education presentations are going to try to get more at the core issues of what if I'm really in favor of a vaccine, but my family members aren't, or my friends aren't, or you know, how do I, I'm worried about these side effects, how do I get more information about them, so trying to more do those relationship components. And then the vaccine consultation process, utilizing like a handout basically, so go through what are they due for, and if it's not a vaccine, we administer it at the site, this is where you could go to get your vaccines, and helping them form a plan. As with smoking cessation, right, if you have a plan, you're more likely to quit smoking, so our thought is if you have a plan on where you're going to get vaccinated and you have your site nurse that sees you a couple weeks later and asks you, hey, did you get that vaccine, that might just help push the needle to get people up to date on their vaccines. And then of course we need to develop that electronic bidirectional communication between the EMR and the state registries, because without that, we're not as effective, we can't scale up our intervention. So our pilot sites, we picked one that's manufacturing, one that's R&D, lab office setting, you know, different regions of the country, both are fairly large sites, the manufacturing site of course, almost everyone's working on site and production versus R&D, it's a hybrid situation, both have very strong nurses to promote the efforts. The prior vaccine efforts at these sites, they already have been engaged and committed to vaccination for many years, having annual flu clinics, as I said, very high participation on online surveys, having multiple COVID vaccine clinics, the one site even had clinics in 2022. So everywhere had a lot of clinics in 2021, but it was very impressive, they kept going. And then of course, you know, other basic vaccines that normally you would carry either in the manufacturing or in an environment where you have travel, then you would have your travel clinic. So our proposed activities with incentives at the pilot sites are going to be a baseline survey, group vaccine education sessions, an online vaccine module, and individual site nurse consultations, and then a follow-up survey. Just an example for the baseline survey, we were looking at the adapted vaccine hesitancy scale that was published by Luton in 2019, and then kind of put that into the socioecological model. So the two questions that were on that survey were vaccines are important for my health, and being vaccinated is important for the health of others in my community. And then we tried to put in some other questions in there that get at relationships. So what is motivating people to get vaccinated? And the survey will have, has additional questions as well about your reasons for hesitancy, your trust, you know, on where you seek information, general knowledge about vaccinations. So this is just a sample. And then our resources for those, for the adult vaccine education sessions, especially our online module is going to be heavily based on CDC because there's just great resources out there. So, you know, what are the vaccines you need as an adult? I think people don't always think about it. They think about bringing their child in for a vaccination, maybe being bothered to get a flu shot or something, but they don't think about the other things. Especially in my work with executive health, I see a lot of folks don't know about the shingles vaccine recommendation at age 50. So that's always the, at least I always have one thing because they're very healthy individuals. But this year we're focused on COVID and influenza, but we're supposed to take this further over the years into other adult routine vaccinations. The adult vaccine assessment tool, if you've not seen that, is just an excellent resource. It allows people, you know, on their own time to run through, you know, input information about themselves, any health conditions they have, and then it comes out and tells you what vaccines you are due for. So some people really enjoy doing that on their own. Others are really going to like going in, talking with the nurse, and getting feedback from the nurse. So our lessons learned was that email internet access was much higher than we anticipated, at least at this manufacturing site. It's very different across the board, so in future years we may not be as fortunate to be able to use as many online tools, but they're very receptive and engaged at this site. So that's really opened up a lot of possibilities. We were asked to adapt our interventions accordingly, so our R&D site that has, you know, a really strong online engagement process, they're going to have an in-person session, they're going to have a team session, and really utilize all resources for that that bring people together in different ways they enjoy learning. The site nurse consultations, we can make a separate appointment, especially for people that don't normally go to the nurse's office. So people in office settings, most are traveling, don't typically go there. So trying to open this up as a possibility. One of our long-term goals will be that our health insurance plan has different activities that we can carry out in order to reduce our insurance premiums. So one of the long-term sustainability goals is for this to be an option for people to do and participate in. So we don't need to rely on external funding, because we already have it built in in a way that you're already getting a discount on your health insurance plan. So it can make this last long-term. The site nurses, again, as I said, now are able to access the data that they weren't able to before, so that already gives them an additional piece of the puzzle. So they can now target and talk to people who are not up-to-date on vaccinations and have those conversations with them. And then our EMR documentation methods, we're working on those now to make that as easy as possible and then to pull that data out. One thing we learned is we could not use our very popular internal reward system, which is the preferred way to do incentives and to do QI initiatives, but it won't work with the grant because we can't meet the federal contract requirements because of the way the billing is when the points are distributed. So we will have to do a more traditional monetary incentive. But again, from a sustainability standpoint, with these healthy living programs, the more that we incorporate the available tools with our everyday wins, rewards, we'll be likely to keep this going, maybe not incentivize at as high of a level, but still be able to provide people with motivation to continue with the program. And then we also found out we would need to submit an IRB application because we are obtaining information directly from the employees and also administering the incentive. So we're getting that submitted now and then we'll be prepared if this information goes on to publication as part of the larger group. And with that, are there any questions? Thank you for a very clear presentation. I'm just a little confused on a conceptual level. Okay. You're not even placing these questionnaires at arm's length with a university partner. You seem to be doing this, if I'm not mistaken, directly out of management and employee health. As we know of the already existing risk factors for low vaccination rates, they relate to race. That flips back and forth depending on where you are. They relate to ethnic groups. They relate to politics in the country. And therefore, your questionnaires are either asking very invasive questions from the point of view of what management generally asks and what workers tolerate answering for management, or you're ignoring all of that and you're looking for other risk factors or other factors that may be useful, assuming a homogenous population, and that education is the key with incentives. So I'm asking, which of those are you doing and how is it going to work? So first, I would say with a quality improvement initiative, you're trying multiple things. This isn't a traditional research study, university-based, where there's a beginning, a middle, and end. We are, this first year, trying to do this baseline and follow-up survey, and part of that follow-up survey will be program evaluation. The questionnaire, we're working with the site nurses that have really great relationships with their employees. There's also healthy living teams at these sites already as well that we can consult with to get some feedback from them on the questions. The idea is to ask about what motivates them. What are their hesitancies? What is their baseline knowledge? And there is a demographic section to try to look at if there's, we can analyze to look if there's a difference among different racial groups. Our one location is primarily white, but there is a small Hispanic population and a couple other different races as well. Our other site is primarily white, but a very large Hispanic population and a black population as well. So we won't have as much diversity as we would love to have from that perspective, but we are going to capture that information and see if there's anything we can learn from it. Also, this is, to me, QI is the PDSA Plan, Study, Do, Act. So if, as we come along and we're learning from what we're doing, then we refine and change what we're doing. And you have your own embedded medical clinics that reports to the medical department where Dr. Leniak is. So we have, oh sorry, Dr. Baker was saying that we have our own embedded medical clinics. So every site, every manufacturing site, except for maybe like two in the U.S., have an onsite nurse that's there a regular amount of hours. So there's already an incredible amount of trust with that site nurse. There might not have always been trust, I think, with corporate, but we've done everything we can to get to these sites, to do talks, to really be available to people. So we've been interacting with folks for the last, you know, two and a half years of the pandemic, three years of the pandemic. So I guess all I can say is we're doing our best to take into account different opinions and we've already, when we talked with the sites, already made some, adapted some things that we're going to do. And healthy living is a part of our site, so it's really just a component in a project within healthy living. Thank you, Dr. Leniak. And you're going to hear from a variety of different practice styles. So not all of them have embedded clinics. Some are more consultants. Some are, you know, smaller clinic groups. So the next presentation is from Dr. Rajiv Das, who's medical director at Safeway or Albertson Companies. And all these presenters are serving an integral role in delivering the collaborative agreement activities. You can come up. Sorry, I'm pulling up your slide. Hello. So, yes, my name is Raj Das and I'm working with Albertson stores on this collaboration for vaccination. Let me see if I can find the... And I do not have any conflicts of interest and any of my opinions or those of myself, they're not representing my affiliates. However, I am available after the lecture if there are any potential conflicts for me. This is the project team. Denise Algeier is pretty much the lead on this and has been, you know, very focused in terms of developing the program. We also have project managers and a clinical program manager and closely collaborate with the pharmacy team who is able to obtain the vaccines and also assist in delivery of the vaccinations. So this is just kind of a brief summary of the program that Dr. Baker already provided, but as you can see, that's kind of the pathway to how we developed the program and collaborated with the CDC. So we employed a phased plan and basically, as you can see, we selected two what we call distribution centers, those are DCs, where all the supplies for the grocery stores are maintained. And these are nice because they're clusters of employees. It's not as distributed as grocery stores, so we can access people a lot easier. But that doesn't mean that we can't include the retail locations, but since they're more dispersed, it's a little bit more challenging from a physical standpoint and logistical. So for the first year of the program, we're focusing on influenza and COVID, but hopefully later on we're going to add additional sites and also look at other vaccinations that may be important for people. So we collected baseline vaccination data and compared it to benchmarked it against the communities that they're in. So we had one distribution center located in California with a vaccination rate of about 40%. And this was considered an opportunity because the surrounding area had a vaccination rate of about 66%, so that indicated that there was more hesitancy among our employees than there were within the community, and this presented a significant opportunity. There was also a second distribution center located in Pennsylvania. Don't worry, it's not in Philadelphia, but it was a 48%, and with the surrounding community it was approximately 61%. So we completed the primary series of vaccinations initially. So what are the opportunities for the future? We would like to identify the best practices for systemizing vaccine needs assessment in terms of what's our process going to be to determine who needs to be vaccinated and what are the hesitancies and kind of kind of streamline the collaboration with the onsite clinic partners since we're so large. Sometimes we have internal resources like the pharmacy and sometimes we have to rely upon vendors. So there needs to be somewhat of a consistent streamlined process. And as I mentioned we you know establish more collaboration with the pharmacy team and you know basically comes down to communication coordination with the district with the distribution center itself as well. And the primary focus is going to be in improving the assessment of vaccination status and promoting vaccine awareness and education. And so those and so what I'm going to be presenting are basically the tools that we provided to the nurses that are educating the employees to kind of explain what the gaps in knowledge are and you know why it's important to employ a certain form of communication to help people understand why they should get vaccinated. So for our scope of services we did determine a baseline and these included chronic medical conditions. We employed our electronic medical health record which was some it was which was a customized version focusing on covid vaccination. But we also needed to rely upon the the IIS as was mentioned earlier and we need to monitor our EHR and I and the IIS to see if there's any been any change in vaccine in vaccine vaccines administered. And then once again it's assessing the challenges of the barriers to vaccines to vaccine administration. So as you can see from the slide there was a large opportunity for those individuals to to address vaccine hesitancy approximately 75 percent or so of individuals had no interest or were undecided and these were the people that we could then and these are the people that could be targeted. So when we're breaking down the information as you can see that the biggest issues were I'm concerned about safety and I don't trust the science and the safety. So trust was a significant component of vaccine hesitancy and that was something that we identified it needed to be addressed and this is just kind of an idea to give it an idea of some of the number of divisions we have. I've blacked out their locations but you can get a sense of idea of where the priority areas were in terms of the percentage of total people with vaccine hesitancy. And so we had some you know approximately 10 to 15 percent some areas with 10 to 15 percent of individuals that were hesitant to get vaccinated. So this is just kind of a location a map of the stores in rural areas that kind of fit the kind of fit the some of the criteria for the CDC in terms of looking for people in medically underserved areas and in rural areas. I tried to put those two maps together to juxtapose but I couldn't. So please don't ask as far as scope of services that we need we need to develop and implement a quality improvement program that will increase vaccine coverage and our plan is to have a pilot and then kind of expand it to other sites depending on the success of the effectiveness of the tools we employ at the pilot site. And one of the things that we learned is that we need to develop more culturally and linguistically appropriate resources to reach the workers because with our with our employee population we have a lot of varied demographics and a lot of different beliefs. So it has to be very very regional in terms of the approach of education. It can't be one size fits all for employee population. So one of some of the examples of things that we've learned are we need to identify champions and peer educators that are appropriate for that location. We have a trusted voices campaign and so some of the individuals we you know Denise actually was one of the trusted voices would be on a streaming video in the distribution centers where they would have lots of information and just by repetition and frequency people would identify whether when she went to one of the went to one of the locations and the familiarity bred trust. And so I think that was one of the lessons learned. We also have to understand how to develop more than one approach to educate people. It's not just emails it's not just a handout it's not just you know meetings. It's trying to find the most effective tool in in combination to it to meet people. And then the other issue is just operational in terms of streamlining our processes to make sure that when we send people there the people that need to get vaccinated are there and there's a certain coordination examples. So one of the things we've also identified is we need to spend money on our elect our electronic health record. So that the vaccine vaccination protocols are incorporated a little bit better. And as identified earlier there needs to be some type of communication between the IAS and the EHR to more efficiently review the immunization status of employees to because if they get the vaccines with their health care provider we may not be aware of it and we may you know we may may try to bother them with you know information that they don't necessarily need and then we also need to collect the data so that we can actively you know meet our obligations for the grant. So this is some of the information that is actually kind of communicated to the nurses providing the education and you know the issue is that people as you heard from before people need to hear from people that they trust because trust was identified as one of the main barriers to obtain vaccine obtain vaccination. And there is a reference to a study where you know where scientists are highly trusted followed by the individual's health care provider. But you know not everyone has access to a health care provider and therefore and at least in our communities pharmacists serve as trusted health care providers and that presents an opportunity to educate individuals as well. And you know also nurses specifically you know we have a lot of nurses working are identified as the highest trusted profession. Doctors are a number two. But one of the things that's interesting is a trend if you look at Courtney Gallup Cole that that trend of trust has actually gone down for nurses and doctors. So there is an opportunity there I guess for us to kind of elevate ourselves even though we're better than everybody else we're still not as good as we used to be when it comes to that. So two of the kind of interventions that were identified as opportunities to improve our approach to address vaccine hesitancy were one was active listening. And the key is listen and actually listen. Don't try to tell. Don't try to inform but listen first and then ask open ended questions about why are you like this. Why are you like this not not yes and no but try to understand an individual why they're hesitant and give them the opportunity to opportunity to explain in health care a lot of times we try to correct or fix but this is a situation where it's more important to listen and then the opportunity is there to give them the opportunity to empower themselves educate them so that they can make the decision. It's not you telling them what to do. It's them deciding what to do. And it may sound like the same thing but there is a difference and I think that's an a program approach just from a philosophical approach that can make a difference and hopefully we'll be able to measure that in the future. And the key is that individuals need to find their own reason to get vaccinated. It's not because of the reasons that we're telling them to get vaccinated but it's very personal to them. So we have to understand an individual's perspective and this is some of the key points given to the nurses talking to the individual patients when they're hesitant to get vaccinated. And the key is not to judge. It's to listen and to understand and empathize and it's not to dismiss. And I think that's part of you know part of the process that we have to kind of step back and listen to what people have to say and acknowledge that some of their fears even though they may not make sense scientifically are still appropriate and need to be addressed. And as I stated before you know it's also to find out you know where are people getting their information. What what do they why do they believe that to be true when all of the other information is to the contrary. So it's to deeply understand why people think the way they do and not to dismiss their sources but to ask them to understand and analyze their sources for consistency you know in terms of have they seen any of these things happen etc. And so that that's very important. And then the key issue is also share information to appropriate sources of information so that they can make a determination for themselves. And so part of the key is to ask them why give them opportunities to explain why they should get vaccinated. A lot of times it's kind of compulsory. And so the issue is the return on investment in terms of or the risk analysis you know what are they scared of and what is the likelihood of that of that fear happening. And so I think those are some of the kind of the keys to kind of get them to get a sense of you know what is the likelihood of them to get a sense of convincing themselves about what they need to do and then addressing some of the logistical issues. You know is it transportation. Is there something that stopping you from getting it done today. And so give them an opportunity to get things done as quickly as possible when they when they when the opportunity presents itself. And one common one common you know issue is fear of needles. And how do you address that. You know I always like to tell people that it's appropriate to be afraid of needles. I actually don't like people that like needles. So it's so it's a yes so it's completely legit. And then the issue is in terms of what are the approaches you can have and you know in you know in our typical clinical scenario people are in pain and we're offering them injections and they're scared of the needle. And I guarantee them that the pain from the needle is a lot less than the pain that is preventing them from doing what they need to do. And it will be a lot more temporary with the vaccination it's a little bit different but still kind of the same you know the same process is you know relaxation strategies some of the cognitive behavioral therapy approaches that we work with for individuals but you know it's a very brief little pinch and if it's done appropriately and well there's usually not nothing to worry about. So what are some of the lessons learned. We need to make it personal. People are more likely to trust someone they can relate to. So we talked about some of the demographics and the ethnicities etc. So those are the kinds of individuals that they can relate to. So if there's a pharmacist with the same ethnicity of the majority of the of that population in that workforce that can be a little bit more helpful and useful in terms of addressing some of the concerns and identifying what the concerns of that population and being able to demonstrate this is why it's OK. This is why I plan to get vaccinated and I'm not hesitant about getting vaccinated. And yes I do understand and I empathize with why you don't want to get vaccinated and I think that's kind of the key. So what we're looking to in the future as far as some of the plans to hopefully kind of address vaccine hesitancy are streaming videos because we have these already as educational opportunities. You know all the time they're persistent and people actually do pay attention. They don't turn them off. So I think that presents an opportunity store directors usually have meetings and huddles with employees so kind of getting at the ground level in terms of having them educate explain that about the vaccination vaccination opportunities and let them know they've got the time to go get it done. And another concept in terms of active versus passive clinics you know typically when we would have a clinic we would have someone there sitting at a booth with a needle waiting for people to stop by. And what we found is that people that were actually enthusiastic and went out talking to people and you weren't it wasn't like you're trying to go out there and corral anybody but at the same time just letting you know that letting people know that you're there you have a smile on your face you look trustworthy come on down and it actually made an impact. And so that's one of the things that people are going to try to be doing is not just be stuck in the corner somewhere but making themselves a little bit more prominent of course without interfering with the work you know work productivity etc because that's important. And also just from a philosophical standpoint active listening and that's really kind of the key from an education standpoint. No judgment just not trying to explain to anybody why they're wrong but rather just understand and listen and then also kind of come from the approach that if someone chooses not to get vaccinated it's not because they can't understand what we're saying it's because we're not communicating it well. And I think that frame shift actually hopefully will be a little bit more effective in the future and it's kind of based upon some of the principles that have already been you know kind of reviewed and provided. That's the conclusion. Any questions. Thank you. Thank you both for your great talks. So you just heard two different corporate settings how they're approaching this vaccine project. As you know Ahmed there's a lot of variety varieties the spice of life right. So we all do things differently. We all may have different patient populations different work settings. One of the corporate has in clinic clinics in their manufacturing site and other ones. Distribution sites may have some nurses but may have to get the shots done at a pharmacy. We are going to take a break until two forty five and after that we'll hear from two other different types of practices. One is from a university setting University of California San Diego and then the other one is a kind of smaller bread and better occupational medicine setting. So to give you the perspective of you know what these different work settings are doing for vaccine hesitancy. Any questions. OK. So again a break until two forty five.

vaccination rates

occupational settings

vaccine hesitancy

trust issues

quality improvement interventions

education sessions

personalization

vaccine uptake