Planned Community Change

By Ashley Borowiak, Christy Rapoza,

& Andrew Tipton

Influenza Analysis

❏ In the United States, Influenza and Pneumonia are the 9th leading cause of death with 50,097 total deaths in 2010. Of those deaths, 1,529 were in Michigan (CDC, 2013).

❏ One of the Healthy People 2020 goals is to increase immunization rates and reduce preventable infectious diseases. “Vaccines are among the most cost-effective clinical preventive services” (HealthyPeople.gov, 2013).

❏ Of the 82 Michigan counties listed in the next slide, Kent county is listed as the 16th highest with an Influenza & Pneumonia death rate of 20.99/100,000 population (World Life Expectancy, 2013).

❏ Michigan has a death rate of 15.55/100,000 population (CDC, 2013).

❏ The Health Belief Model will explain why Kent County has a higher death rate related to Influenza than other Michigan counties.

MICHIGAN INFLUENZA AND PNEUMONIADeath Rate Per 100,000

Counties

Schoolcraft 1.Ogemaw 2.Ontonagon 3.Barry 4.Allegan 5.Arenac 6.Mackinac 7.Ionia 8.Iron 9.Montcalm 10.Clare 11.Van Buren 12.Calhoun 13.Gratiot 14.Alger 15.Kent 16.Bay 17.Roscommon 18.Dickinson 19.Ottawa 20.Sanilac 21.Cass 22.Branch 23.Iosco 24.Marquette 25.Gogebic 26.Wayne 27.Alcona 28.Mason 29.Baraga 30.Crawford 31.Delta 32.Osceola 33.Luce 34.Jackson 35.Newaygo 36.Kalamazoo 37.Ingham 38.St. Clair 39.Muskegon 40.Gladwin 41.Manistee 42.Livingston 43.Shiawassee 44.Isabella 45.Oscoda 46.Antrim 47.Berrien 48.Kalkaska 49.Huron 50.Eaton 51.Mecosta 52.St. Joseph 53.Genesee 54.Hillsdale 55.Lake 56.Oceana 57.Washtenaw 58.Lapeer 59.Oakland 60.Charlevoix 61.Presque Isle 62.Montmorency 63.Saginaw 64.Missaukee 65.Clinton 66.Alpena 67.Menominee 68.Tuscola 69.Leelanau 70.Benzie 71.Midland 72.Wexford 73.Macomb 74.Cheboygan 75.Otsego 76.Chippewa 77.Lenawee 78.Houghton 79.Emmet 80.Monroe 81.Grand Traverse 82.Keweenaw 83.

In order to get enough data to display county rankings multiple years must be used. Recently the CDC has begun suppressing even more counties. If your county is not included that is the reason.

To review the full interactive chart visit http://www.worldlifeexpectancy.com/usa/michigan-influenza-pneumonia

Groups greatly affected by Influenza❏<2 years old❏>65 years old❏Anyone with a chronic health condition that has a high risk

of complications

“It's estimated that 90 percent of seasonal influenza-related deaths and more than 60 percent of seasonal influenza-related hospitalizations in the United States each year occur in people 65 years and older”(CDC, 2013).

❏Possible reasons this problem continues in the 65 years and older group is due to a lack of education and understanding regarding the vaccine, the cost of the vaccine, transportation issues, and misunderstandings regarding Tamiflu.

❏Possible barriers include:❏Cost of the vaccine❏Transportations issues.❏Multiple co-morbidities and a generally weakened

immune system

❏ Data shows that sixty seven deaths in 2010 were from Influenza or Pneumonia and 85% of these deaths occurred in the population 65 years of age and older (Access Kent, 2013).

❏ In 2010, Influenza/Pneumonia was the 9th leading cause of death among Kent County residents (Access Kent, 2013).

❏With the death rate of influenza reaching 90% nationally and 85% in Kent county, this becomes a social ecological issue at the mainstream (population or community) level (Harkness, 2013)

❏This problem cannot be managed by the health department alone. The utilization of additional resources such as primary care providers, pharmacies and local immunization health fairs will be necessary.

❏The Area Agency on Aging of Western Michigan, due to a Kent County millage, provides services including influenza immunizations to this population (aaawm.org).

Problem Statement

Adults ranging from ages 65-74 in Kent County, Michigan are at an increased risk of developing influenza and related complications or death, as evidenced by an increase in deaths over the last three years (Access Kent, 2013).

❏ Lack of influenza vaccination❏ Active & passive cigarette smoke exposure❏ Chronic illnesses and underlying conditions such as

COPD, asthma & diabetes❏ Improving hand hygiene❏ Maintaining a healthy diet and weight❏ Avoiding crowded areas or areas where others are

infected with influenza

Modifiable Risk Factors

American Thoracic Society, 2013

❏ Co-morbidities resulting in weakened immune systems

❏ Others in the community not taking proper precautions.

❏ Underlying conditions which are genetic in nature (though controlling these conditions can help decrease your risk of developing influenza and complications).

Risk Factors Unable to be Modified

Interventions

Our interventions focus on education regarding the importance of the influenza vaccine, its availability and cost, possible transportation issues, and the effects of Tamiflu.

Prevention Strategies by means of InterventionPrimary

❏ Get vaccinated!❏ Educate those who are at

risk❏ Individuals with

diabetes, respiratory issues, HIV/AIDS, heart disease, cancer and who are pregnant

❏ Educate on how to practice good hygiene habits

Secondary

❏ Educate the public on the following:❏ Take antiviral if

influenza diagnosed❏ Take regular

medications as prescribed to avoid complications if contracted

❏ Stay home and take precautions when infected to prevent spreading

Centers for Disease Control, 2013

Immunization Drive

❏ Coordinate with the Kent County Public Health Department main office and their four (4) satellite departments to host immunization drives. These drives would focus on those 65 years and older.

❏ Encourage local businesses to donate items to use in a raffle in exchange for having their name on the drive poster, this will encourage the community to become involved.

❏ Everyone who gets their vaccine will be entered in the raffle, and if they are over the age of 65, their name will be entered twice.

❏ Community interest❏ Coordinate with a local radio station for airtime each

week to educate the public on influenza vaccination and have a physician on stand by to ask questions in promotion of influenza drive.

❏ Approach employers and large corporations to offer 8 hours of PTO for employees who get the influenza vaccination at the influenza drive.

❏ Take up ads in the local newspaper to promote drive.

❏ The influenza drive would be coordinated with the health department, and permission would need to go through them while abiding by their policies for vaccination clinics.

"National Influenza Vaccination Week (NIVW) is a national observance that was established to highlight the importance of continuing influenza vaccination. NIVW is December 8-14, 2013“ (CDC, 2013)

With most influenza clinics offering vaccines between September and November this will be our final chance to highlight the importance of getting vaccinated. During this week, to provide awareness we will…

❏ Send out fliers to homes of individuals stressing the importance of getting vaccinated and where our final Influenza drive will be located.

❏ Utilize local newspaper and radio stations for advertising this event.

❏ Arrange for transportation to and from vaccination sites for those who are unable to transport themselves.

Availability

❏ Influenza vaccines are available through the Kent County Health Department

❏ Primary Care Physician

❏ Urgent Care Facilities

❏ Vaccines are also available at local CVS, Kmart, Meijer, and Wal-Mart pharmacies.

❏ https://flunearyou.org/ is a great website that monitors flu symptoms but also allows you to put in your zip code and it lists places near you where the Influenza Vaccine is being offered.

Cost❏ Kent County Health Department

offers vaccines for a sliding scale. The cost is $25/29/30 (Access Kent, 2013).

❏ Most insurance is accepted including Medicare part B at all pharmacies

Tamiflu

❏Tamiflu is an antiviral medication used to treat symptoms of the flu. It is not a replacement for the vaccine.

❏In 2012 there was a huge increase in the number of confirmed cases of Influenza in Kent County, because of this many pharmacies were running out of the antiviral medication Tamiflu.

❏David Miller, owner of Keystone Pharmacy which is located in Kent County, stated in regards to the Tamiflu shortage, “It underscores the importance of people getting the flu shot prophylactically” (Thoms, 2013).

❏The evidence-based practice which fits this situation is the increased rate of acceptance of the Influenza vaccine among the 65 and older population along with a decreased mortality rate.

Evaluation

The desired outcomes would be a decreased death rate in the 65 year and older population related to influenza, and that influenza will no longer be one of the top 10 common causes of death in Kent County.

Evaluation Period❏ Will evaluate death rates at the end of every influenza season❏ Will continue to monitor number of vaccines obtained throughout influenza

season to track current progress of effectiveness of interventions

Interim Outcomes❏ Outcomes will be measured throughout the current influenza season by

comparing the number of vaccinations with those from previous years at this time.

❏ Outcomes can be tracked during the influenza season by following the number of influenza related admissions through the local emergency departments and influenza diagnoses from physicians offices and walk-in clinics.

How will we measure outcomes?Previous data in Kent County using their existing tracking systems:❏ Physician Reports❏ Laboratory Reports❏ Infection Control Departments❏ Daycares, Schools & Camps weekly reports❏ Emergency Departments

By tracking the number of vaccinations administered and documented cases of influenza and complications from the disease, we can compare these numbers with previous numbers in Kent County.

These outcomes will also be compared with those at the state and federal level to determine if our interventions are effective with outcomes being met with the help of Kent County’s Epidemiology Unit.

Access Kent, 2013

References

❏ Access KENT (2013). Monitoring Influenza in Kent County. Retrieved from http://www.accesskent.com/Health/CommDisease/Flu/flu_monitoring.htm

❏ American Thoracic Society (2013). Influenza-”The flu” 2013-2014 season update. Retrieved from

http://patients.thoracic.org/information-series/en/resources/influenza-the-flu.pdf

❏ Centers for Disease Control and Prevention (2013). CDC Influenza Update for Geriatricians and Other Clinicians Caring for People 65 and Older. Retrieved from http://www.cdc.gov/flu/professionals/2012-2013-guidance-geriatricians.htm

❏ Centers for Disease Control and Prevention (2013).National Vital Statistics Reports 61(4), 5,87. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf

❏ Centers for Disease Control and Prevention (2013).National Influenza Vaccination Week. Retrieved from http://www.cdc.gov/flu/nivw/index.htm

❏ Centers for Disease Control and Prevention (2013). Seasonal influenza (Flu). Retrieved from http://www.cdc.gov/flu/

References

❏ Harkness, G.A., & DeMarco, R.F. (2012). Community and public health nursing practice: Evidence for practice. Philadelphia:Wolters Kluwer/Lippincott, Williams, & Wilkens.

❏ HealthyPeople.gov (2013).Immuniation and Infectious Disease. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23

❏ Kent County Senior Millage, 2013 services. Referenced from: http://www.aaawm.org/millage_services

❏ World Life Expectancy (2013).Michigan Influenza & Pneumonia.. Retrieved from http://worldlifeexpectancy.com/usa/michigan-influenza-pneumonia

❏ Thoms, Sue (2013). Jump in flu cases may be straining Tamiflu supply In Grand Rapids. Retrieved from http://www.blog.mlive.com/grpress/news_impact/print.html?entry=/2013/01/short_supply_of_tamiflu_report.html