Mandy A Allison

Children's Hospital Colorado, Aurora, Colorado, United States

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Publications (28)61.56 Total impact

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    ABSTRACT: School-based health centers (SBHCs) have been suggested as possible patient-centered medical homes. Our objectives were to determine, in a low-income, urban population, adolescents' reasons for visiting SBHCs and the value parents place on SBHC services, and adolescents' and parents' assessment of how well SBHCs fulfill criteria for a medical home as defined by the American Academy of Pediatrics.
    Pediatrics. 10/2014;
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    ABSTRACT: Because of high purchase costs of newer vaccines, financial risk to private vaccination providers has increased. We assessed among pediatricians and family physicians satisfaction with insurance payment for vaccine purchase and administration by payer type, the proportion who have considered discontinuing provision of all childhood vaccines for financial reasons, and strategies used for handling uncertainty about insurance coverage when new vaccines first become available. A national survey among private pediatricians and family physicians April to September 2011. Response rates were 69% (190/277) for pediatricians and 70% (181/260) for family physicians. Level of dissatisfaction varied significantly by payer type for payment for vaccine administration (Medicaid, 63%; Children's Health Insurance Program, 56%; managed care organizations, 48%; preferred provider organizations, 38%; fee for service, 37%; P < .001), but not for payment for vaccine purchase (health maintenance organization or managed care organization, 52%; Child Health Insurance Program, 47%; preferred provider organization, 45%; fee for service, 41%; P = .11). Ten percent of physicians had seriously considered discontinuing providing all childhood vaccines to privately insured patients because of cost issues. The most commonly used strategy for handling uncertainty about insurance coverage for new vaccines was to inform parents that they may be billed for the vaccine; 67% of physicians reported using 3 or more strategies to handle this uncertainty. Many primary care physicians are dissatisfied with payment for vaccine purchase and administration from third-party payers, particularly public insurance for vaccine administration. Physicians report a variety of strategies for dealing with the uncertainty of insurance coverage for new vaccines.
    PEDIATRICS 02/2014; · 4.47 Impact Factor
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    ABSTRACT: Adults are at substantial risk for vaccine-preventable disease, but their vaccination rates remain low. To assess practices for assessing vaccination status and stocking recommended vaccines, barriers to vaccination, characteristics associated with reporting financial barriers to delivering vaccines, and practices regarding vaccination by alternate vaccinators. Mail and Internet-based survey. Survey conducted from March to June 2012. General internists and family physicians throughout the United States. A financial barriers scale was created. Multivariable linear modeling for each specialty was performed to assess associations between a financial barrier score and physician and practice characteristics. Response rates were 79% (352 of 443) for general internists and 62% (255 of 409) for family physicians. Twenty-nine percent of general internists and 32% of family physicians reported assessing vaccination status at every visit. A minority used immunization information systems (8% and 36%, respectively). Almost all respondents reported assessing need for and stocking seasonal influenza; pneumococcal; tetanus and diphtheria; and tetanus, diphtheria, and acellular pertussis vaccines. However, fewer assessed and stocked other recommended vaccines. The most commonly reported barriers were financial. Characteristics significantly associated with reporting greater financial barriers included private practice setting, fewer than 5 providers in the practice, and, for general internists only, having more patients with Medicare Part D. The most commonly reported reasons for referring patients elsewhere included lack of insurance coverage for the vaccine (55% for general internists and 62% for family physicians) or inadequate reimbursement (36% and 41%, respectively). Patients were most often referred to pharmacies/retail stores and public health departments. Surveyed physicians may not be representative of all physicians. Improving adult vaccination delivery will require increased use of evidence-based methods for vaccination delivery and concerted efforts to resolve financial barriers, especially for smaller practices and for general internists who see more patients with Medicare Part D. Centers for Disease Control and Prevention.
    Annals of internal medicine 02/2014; 160(3). · 13.98 Impact Factor
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    ABSTRACT: Objectives: School based health centers (SBHCs) can be a convenient source of primary health care. SBHCs often focus on underserved populations and offer services during school hours usually without parents present. Little is known regarding parental satisfaction with SBHCs care and the reasons they enroll their child in this model of care. The objectives of this study were to assess parental satisfaction with the care provided within SBHCs and reasons for parents enrolling their children into SBHCs. Methods: A mail survey in English and Spanish among a random sample of parents of adolescents enrolled in one of 10 Denver SBHCs. Incentives ($5) were included in the 1st mailed survey, and up to 5 mailings were sent. All SBHCs in the study are located in secondary schools and operated by the same delivery system. Results: The response rate was 36% (181/497). Thirty-three percent reported that the SBHC was their child's main source of care; 83% of respondents reported that they could always/usually trust the SBHC provider to take good care of their child and 82% were satisfied with provider to provider communication. Parents cited the most common reason for SBHC visits were vaccines (77%), regular check-ups (70%) and illnesses (62%). Reasons parents chose to sign their child up for the SBHC are shown in Table 1. Conclusions: Parents of teen users of SBHCs report a high degree of trust in providers, and most parents are satisfied with the communication they receive. Reasons to utilize SBHCs are similar to traditional primary care sites. There is significant value placed by parents on SBHCs’ convenience, provision of desired services and lack of financial barriers to care. Very important Somewhat important A little/not at all important Was not aware Can see my child when he/she is sick 85 10 3 2 Can give physical exams for sports 79 8 5 9 Can give my child vaccinations 78 9 7 5 My child misses less school when the they get care there 76 12 8 5 I don't need to miss work for my child to receive care there 74 13 8 5 Can give regular checkups 72 15 5 9 Doesn't require insurance to be seen 71 9 7 13 Doesn't have a co-payment 69 9 7 15 Can give my child education about sexual health 64 19 8 9 Can give my child exercise/dietary counseling 49 17 16 17 Can provide mental health services 43 16 13 29
    2013 American Academy of Pediatrics National Conference and Exhibition; 10/2013
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    ABSTRACT: Objectives: The patient-centered medical home (PCMH) is defined by the AAP as care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. School based health centers (SBHCs) have been shown to increase access to care for adolescents, but their fulfillment of the criteria for a PCMH has not been examined from the client perspective. The objectives of this study were to assess utilization, perceived quality, and characteristics of the criteria for a PCMH from the perspective of teen users of Denver SBHCs. Methods: Surveys were mailed to a random sample of teen users of 10 SBHCs in Denver, CO 5/2012-10/2012. Eligible teens were registered for the SBHC with at least one visit during the 2011-2012 school year. All criteria of the PCMH were examined except family-centered care. Results: The response rate was 40% (198/495). Among teens, 79% reported visiting the SBHC ≥3 times in the last year, 34% reported it was their main source of medical care, and 19% had a chronic medical condition. Most teens were very (67%) or somewhat (30%) satisfied with the care they received. Regarding quality of care, 88% reported that providers usually/always were helpful, listened carefully (88%), explained things well (88%), showed respect (93%), spent enough time (85%), and explained that care was confidential (90%). Table 1 shows questions addressing aspects of the PCMH. Conclusions: In a low-income urban population, SBHCs met most criteria of a PCMH from the perspective of teens they served. Policy makers and communities should consider SBHCs as a way to provide a medical home for underserved adolescents while addressing any areas of weakness. Excellent (%) Good (%) Fair (%) Poor (%) Accessible Is available when I need to be seen 31 46 17 5 Continuous Has providers that know me 28 39 26 8 Comprehensive Offers lots of different services 24 49 22 5 Coordinated Able to see specialists if needed 23 50 21 6 Compassionate Provides a kind, caring place for health care 40 46 13 2 Culturally Effective Respects my family's cultural values 36 47 15 2
    2013 American Academy of Pediatrics National Conference and Exhibition; 10/2013
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    ABSTRACT: OBJECTIVES: To ascertain, through two separate surveys among nationally representative networks of pediatricians (Peds) and family physicians (FM): 1) physicians' reported level of confidence in pre- and post-licensure vaccine safety studies; and 2) changes in reported level of confidence from 2007 to 2010/11. METHODS: Two surveys conducted August to October 2007 and November 2010 to January 2011. The survey response rates were 81% (FM, 79%, Peds, 84%, p=0.07) for the 2007 survey (691/848) and 66% (FM, 61%, Peds, 70%, p=0.003) for the 2010/11 survey (532/811). RESULTS: One in three family physicians compared to one in ten pediatricians in both surveys reported little or no confidence in pre-licensure vaccine safety studies (p<0.001). Compared to pre-licensure studies, higher percentages of both specialties reported a great deal of confidence in post-licensure vaccine safety studies in both years, and more physicians from both specialties reported a great deal of confidence in 2010/11 than in 2007. CONCLUSION: While most family physicians and pediatricians report confidence in post-licensure vaccine safety studies, one third of family physicians report little or no confidence in pre-licensure studies. More research is needed to better understand the reasons behind some physicians' lack of confidence in vaccine safety studies.
    Preventive Medicine 01/2013; · 3.50 Impact Factor
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    ABSTRACT: Pentavalent rotavirus vaccine (RV5) was recommended for routine use in 2006 followed by monovalent rotavirus vaccine (RV1) in 2008. To describe, among a U.S. sample of pediatricians (n=289 respondents) and family medicine physicians (n=243 respondents), (1) current practices regarding rotavirus vaccine (RV) and barriers to use with comparison to a 2007 survey and (2) knowledge of recent safety concerns regarding RV1 and their impact on its use. A mail and Internet survey was conducted with the physicians, from November 2010 to January 2011; analyses were conducted March-September 2011. Response rates were 70% (289/410) for pediatricians and 61% (243/401) for family medicine physicians; routine administration of RV was reported by 95% of pediatricians and 65% of family medicine physicians (2007: 85% and 45%). Almost all barriers to use of RV had decreased compared to 2007. For pediatricians and family medicine physicians, respectively, 94% and 70% were aware of the temporary suspension of RV1 due to presence of porcine circovirus; 49% and 45%, respectively, were aware of the addition to RV1 labeling regarding a possible increased risk of intussusception. Among physicians aware of the safety issues, <5% reported stopping giving RV as a result. After reading information about porcine circovirus, 35% of pediatricians and 59% of family medicine physicians reported it had increased their own concerns about the safety of RV; and 31% and 60%, respectively, reported this regarding intussusception. The acceptance of RV has increased, and barriers to use have decreased. Among physicians, recent safety questions about RV1 have not affected use of RV, although they have raised safety concerns.
    American journal of preventive medicine 01/2013; 44(1):56-62. · 4.24 Impact Factor
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    ABSTRACT: Background: The first cases of pandemic H1N1 influenza in Utah were recognized in the Park City School District (PCSD). Officials closed PCSD schools because they could not determine the extent of the outbreak. New rapid viral diagnostic technology could aid officials by providing immediate information regarding the presence of pathogens among students. Purpose: 1)Conduct a school-based drill to determine the feasibility of testing students for respiratory pathogens; 2)Engage students in the process. Significance: Students have the opportunity to learn about the public health system and biotechnology. PCSD will be better prepared when infectious disease outbreaks occur. Methodology: Students from a PCSD Biotechnology class worked with the local health department, Idaho Technologies Inc.(ITI), and the University of Utah to learn about viral diagnostic technology and develop a drill protocol. A drill was conducted in 2/12 involving anterior nare swabs and symptom surveys collected from students. Students worked with the investigators to test swabs for respiratory pathogens using the ITI point-of care(POC) FilmArray device. Results: Samples and surveys were collected from 78 students. Thirty-seven(47%) reported fever, cough, or sore throat and 4(5%) met the definition for influenza-like illness. H1N1 influenza, parainfluenza 2, and rhinovirus were detected. Most students(78%) reported minimal or no discomfort with testing and 81% thought other students would probably participate in the future. Conclusions: Conducting a school-wide drill using POC diagnostics to screen for respiratory pathogens is feasible. We created a successful academic-health department-school-small business partnership to engage students in public health and prepare schools for outbreaks.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: Background Utah students are at risk for fatal anaphylaxis in school due to lack of: school nurses, adequately trained school staff and standardized approach to food allergy emergency planning. The Utah Emergency Injection for Anaphylactic Reaction Act allows trained individuals to administer unassigned epinephrine in an emergency; however, few schools are prepared to do this. Program Goals * Help Utah schools identify children at risk for anaphylaxis due to food allergy. * Develop a Food Allergy Action Plan for each identified child in conjunction with parents, school nurses and physicians. * Train school staff to know when and how to administer epinephrine. * Ensure that each school has access to unassigned epinephrine. Program Description Beginning May 2011, A Shot to Live has sought to accomplish these goals by: * Forming community partnerships * Raising awareness of food allergies in schools * Developing a standardized, web-based curriculum that helps trainees: * Understand the impact of food allergies on school children * Recognize anaphylaxis * Learn how to treat anaphylaxis using an epinephrine auto-injector (Epipen) * Assisting schools to acquire unassigned epinephrine by: * Clarifying Utah law * Identifying a prescribing physician * Obtaining funding Evaluation A Shot to Live is funded by an AAP resident CATCH grant. Our community partnerships include the Utah Food Allergy Network (UFAN), the Utah Medical Association (UMA), the Utah School Nurses Association (USNA) and the Utah Department of Health (UDOH). We generated support from parents of food allergic children through our alliance with UFAN. UFAN recently obtained a grant through the Food Allergy and Anaphylaxis Network to purchase their comprehensive school food allergy management program for every Utah school district and will incorporate the Shot to Live training in their presentation of this curriculum. We garnered Utah physicians’ support through passage of a resolution in the UMA. The USNA adopted our training, which will be presented to every Utah school nurse via webinar. We created the curriculum in cooperation with UDOH and school nurses. Our curriculum incorporates a registration feature that allows UDOH and school nurses to track trainees and know when annual refresher training is due. We determined the current availability of unassigned epinephrine and number of trained first responders in Utah schools. Dey Pharmaceuticals donated Epipen trainer devices and their school discount for Epipens is publicized on our website (ashottolive.org). As a result of our efforts, the Salt Lake City School District will require each of its schools to stock an unassigned Epipen. Discussion Our campaign aims to reduce the morbidity and mortality associated with school-related anaphylaxis by ensuring that each school has an unassigned Epipen and trained staff. Through community partnerships, a standardized online curriculum and a registration system we have created a sustainable school health intervention.
    2012 American Academy of Pediatrics National Conference and Exhibition; 10/2012
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    ABSTRACT: Background: Immunization information systems (IIS) are confidential, computerized, population-based systems that consolidate vaccination data from multiple providers. IIS are available in 49 out of 50 states, are effective at increasing vaccination coverage, and can streamline the process of recording vaccine information and tracking vaccine inventory. The objectives of this study were to assess among US pediatricians: 1) awareness and use of IIS; and 2) current systems for recording vaccinations and tracking vaccine supplies. Methods: Between 9/2011 and 1/2012, we administered an Internet and mail survey to a national network of pediatricians representative of the American Academy of Pediatrics membership. Results: The survey response rate was 71% (288/408). Among respondents, 75% reported that their state/region had an IIS, 8% that they did not, and 18% were unsure; 66% reported having an EMR/EHR. Overall, 59% reported participating in an IIS. Among those participating in an IIS, 29% transmitted data by automatic uploads and 58% reported that they had to enter data manually. The most common methods for recording vaccine product, lot number and expiration date in the medical record were direct entry into an electronic (52%) or paper-based (27%) record. Seventy-six percent reported recording this information in 2 or more places. Eighty-seven percent noted that recording vaccine information was time-consuming and 33% reported problems with accurately maintaining vaccine records. Regarding vaccine inventory, physicians reported ordering vaccine based on expected seasonal increases in demand (55%), paper-based inventory (52%), or when stock looks low (47%). Few physicians used IIS- or Internet-based inventory systems (21%) or inventory software systems (9%). Seventy-nine percent reported it was time consuming to keep track of inventory and 24% reported their practices frequently run out of vaccines. Conclusion: While most pediatricians currently participate in an IIS, current systems of recording vaccine doses and tracking vaccine inventory are duplicative, time-consuming and often not linked to the IIS. Providers can access the full potential of the IIS by utilizing EHRs, establishing electronic data exchange with IIS using HL7 messaging, and taking advantage of inventory management tools in IIS.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
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    ABSTRACT: Determine among a representative sample of pediatricians (Peds), family medicine (FM), and general internal medicine (GIM) physicians in the 2009-2010 influenza season physicians': 1) practices and experiences with delivery of seasonal and pH1N1 influenza vaccines; and 2) anticipated and experienced barriers. Two US national surveys administered 7/2009-10/2009 (before pH1N1 distribution) and 3/2010-6/2010 (after pH1N1 distribution) to 416 Peds, 424 FM and 432 GIM. Of respondents who received both surveys, 62% (776/1253) completed both. Overall, 98% reported administering seasonal influenza vaccine and 86% pH1N1, with 70% reporting that working with public health in delivery of pH1N1 was a positive experience. Due to limited supplies of pH1N1, 63% of providers reported prioritizing who received vaccine even within high risk groups. Pre-distribution, 71% perceived that patient/parental safety concerns about pH1N1 would be a barrier, and post-distribution 72% perceived it had been a barrier. Physician concern about safety decreased, with 44% reporting safety a barrier pre-distribution and 12% post-distribution (p<0.001). In the setting of a pandemic most primary care physicians collaborated with public health in delivery of pH1N1. Physicians faced challenges with patient/parent safety concerns about pH1N1 and supply issues with pH1N1 that required physicians to prioritize who received vaccine.
    Preventive Medicine 04/2012; 55(1):68-71. · 3.50 Impact Factor
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    ABSTRACT: The meningococcal conjugate vaccine (MCV4) was recommended for those aged 11-18 years in 2005. Initial supply issues led to an emphasis on immunizing older adolescents. When supply improved in 2007, routine immunization was recommended for those aged 11-12 years. Among a U.S. sample of pediatricians and family medicine physicians, describe (1) recommendation and administration practices for MCV4; (2) preferences regarding MCV4 administration; and (3) attitudes and characteristics associated with recommendation for those aged >12 years. A mail and Internet survey in a nationally representative sample of physicians was conducted between December 2009 and March 2010. Analysis was conducted between March 2010 and October 2010, including a multivariable analysis to examine factors associated with deferring MCV4 to ages >12 years. Response rates were 88% (pediatricians 367/419) and 63% (family medicine physicians 268/423). In all, 95% of pediatricians and 73% of family medicine physicians reported administering MCV4 routinely to those aged 11-18 years (p<0.0001); 83% (pediatricians) and 45% (family medicine physicians) reported strongly recommending MCV4 for those aged 11-12 years (p<0.0001); 27% (pediatricians) and 40% (family medicine physicians) preferred to administer MCV4 to those aged >12 years (p<0.0001). Compared with those who strongly recommend for those aged 11-12 years, physicians who do not regularly stock MCV4, family medicine physicians, and physicians concerned about waning immunity were more likely to defer their recommendation, whereas physicians practicing in the Northeast and those with more Latino patients were less likely to defer. Most pediatricians and family medicine physicians administer MCV4, but many, especially family medicine physicians and those concerned about waning immunity, defer their recommendation for MCV4 to patients aged >12 years.
    American journal of preventive medicine 12/2011; 41(6):581-7. · 4.24 Impact Factor
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    ABSTRACT: Less than half of adults for whom seasonal influenza vaccine is recommended receive the vaccine. Little is known about physician willingness to collaborate with community vaccinators to improve delivery of vaccine. To assess among general internists and family medicine physicians: (1) seasonal influenza vaccination practices, (2) willingness to collaborate with community vaccinators, (3) barriers to collaboration, and (4) characteristics associated with unwillingness to refer patients to community sites for vaccination. Mail and Internet-based survey. National survey conducted during July-October 2009. General internists and family medicine physicians. Survey responses on vaccination practices, willingness to collaborate to deliver vaccine and barriers to collaboration. Response rates were 78% (337/432 general internists) and 70% (298/424 family medicine physicians). Ninety-eight percent of physicians reported giving influenza vaccine in their practice during the 2008-2009 season. Most physicians reported willingness to refer certain patients to other community vaccinators such as public clinics or pharmacies (79%); to collaborate with public health entities in holding community vaccination clinics (76%); and set up vaccination clinics with other practices (69%). The most frequently reported barriers to collaboration included concerns about record transfer (24%) and the time and effort collaboration would take (21%). Reporting loss of income (RR 1.40, 95% CI 1.03-1.89) and losing opportunities to provide important medical services to patients with chronic medical conditions (RR 1.77, 95% CI 1.25-2.78) were associated with unwillingness to refer patients outside of the practice for vaccination. Surveyed physicians may not be representative of all physicians. The majority of physicians report willingness to collaborate with other community vaccinators to increase influenza vaccination rates although some will need assurance that collaboration will be financially feasible and will not compromise care. Successful collaboration will require reliable record transfer and must not be time consuming.
    Vaccine 09/2011; 29(47):8649-55. · 3.77 Impact Factor
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    ABSTRACT: Identifying respiratory pathogens within populations is difficult because invasive sample collection, such as with nasopharyngeal aspirate (NPA), is generally required. PCR technology could allow for non-invasive sampling methods. Evaluate the utility of non-invasive sample collection using anterior nare swabs and facial tissues for respiratory virus detection by multiplex PCR. Children aged 1 month-17 years evaluated in a pediatric emergency department for respiratory symptoms had a swab, facial tissue, and NPA sample collected. All samples were tested for respiratory viruses by multiplex PCR. Viral detection rates were calculated for each collection method. Sensitivity and specificity of swabs and facial tissues were calculated using NPA as the gold standard. 285 samples from 95 children were evaluated (92 swab-NPA pairs, 91 facial tissue-NPA pairs). 91% of NPA, 82% of swab, and 77% of tissue samples were positive for ≥1 virus. Respiratory syncytial virus (RSV) and human rhinovirus (HRV) were most common. Overall, swabs were positive for 74% of virus infections, and facial tissues were positive for 58%. Sensitivity ranged from 17 to 94% for swabs and 33 to 84% for tissues. Sensitivity was highest for RSV (94% swabs and 84% tissues). Specificity was ≥95% for all viruses except HRV for both collection methods. Sensitivity of anterior nare swabs and facial tissues in the detection of respiratory viruses by multiplex PCR varied by virus type. Given its simplicity and specificity, non-invasive sampling for PCR testing may be useful for conducting epidemiologic or surveillance studies in settings where invasive testing is impractical or not feasible.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 08/2011; 52(3):210-4. · 3.12 Impact Factor
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    ABSTRACT: Background: The quadrivalent HPV vaccine (HPV4) was approved for use in males age 9 to 26 years in 2009; the Advisory Committee on Immunization Practices stated that HPV4 can be used for males, but HPV4 was not included in the routine immunization schedule. Objectives: Describe attitudes and current practices related to HPV4 for adolescent males among a sample of pediatricians and family medicine physicians. Methods: Survey of nationally representative sample of physicians conducted by mail and internet between 6/2010 and 9/2010. Results: The response rate was 72% (609/842). Among respondents, 53% strongly and 36% somewhat agree that HPV-related disease is severe enough in females to warrant routine immunization of males; 31% strongly and 42% somewhat agree that HPV-related disease is severe enough in males to warrant routine immunization. When discussing HPV4, 63% would strongly emphasize prevention of genital warts in the patient and 62% would strongly emphasize prevention of cervical cancer in partners. While 20% strongly and 33% somewhat agree that it is necessary to discuss sexual health issues prior to recommending HPV4, only 27% report routinely discussing these issues with11-12 year olds. While 81% would strongly recommend HPV4 for males known to be homo/bisexual, only 11%, 35%, and 51% routinely discuss sexual orientation with 11-12, 13-15, and 16-18 year olds, respectively. Currently, 31% report administering HPV4 to males; 14% strongly recommend HPV4 for 11-12 year old males, 21% for 13-15 year olds, and 22% for 16-18 year olds. Conclusions: Most physicians agree that HPV-related disease is severe enough to warrant routine use of HPV4 in males and would emphasize both the prevention of cervical cancer in partners and prevention of warts in males when discussing the vaccine. Most physicians recognize that men who have sex with men are a group that would benefit from vaccination, but are not routinely asking questions that might identify this group.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
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    ABSTRACT: Background: One dose of the meningococcal conjugate vaccine (MCV4) was recommended for routine use in 11-12 year olds in 2005. Recommendations for a booster dose were added in October 2010. Objectives: Among a U.S. sample of pediatricians (Peds) and family medicine (FM) physicians describe: 1) recommendation and administration practices for MCV4, 2) preferences regarding MCV4 administration, and 3) attitudes and characteristics associated with deferring vaccine recommendation to >12 years old. Methods: A mail and internet survey in a nationally representative sample of physicians conducted between 12/09 and 3/10, prior to recommendations for a booster dose. A multivariable analysis was conducted to examine factors associated with deferring MCV4 vaccination to >12 years. Results: Response rates were 88% (Peds 367/419) and 63% (FM 268/423). 83% of Peds and 45% of FM reported strongly recommending MCV4 for 11-12 year olds (p = 0.001); 95% of Peds and 73% of FM reported routinely administering MCV4 to all eligible 11-18 year olds (p = 0.001). 68% of Peds and 35% of FM preferred to administer MCV4 to 11-12 year olds; 27% of Peds and 50% of FM prefer to administer MCV4 at older ages (p<0.0001). Both Peds (24%) and FM (32%) were concerned about waning immunity (p = 0.3). Compared to those who strongly recommend at 11-12, physicians who do not regularly stock MCV4, FM, and physicians concerned about waning immunity were more likely to defer their recommendation, while physicians practicing in the Northeast and those with more Latino patients were less likely to defer. Conclusions: Most Peds and FM strongly recommend and routinely administer MCV4, but many choose to give it to patients older than 11-12 years old. New recommendations for a booster may encourage those concerned about waning immunity to recommend the first dose at 11-12 years or may reinforce a preference to defer recommendation to later ages.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
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    ABSTRACT: Background: In response to the emergence of a novel strain of influenza a rapid international response occurred including the expedited production of a vaccine. Primary care physicians' experiences with delivery of the vaccine have not been described. Objectives: To determine, among primary care physicians: 1) willingness to administer Influenza A (H1N1) 2009 Monovalent Vaccine (pH1N1); 2) experiences with pH1N1 supply and delivery; and 3) perceived barriers to administration of pH1N1 during the 2009-2010 influenza season. Methods: Two surveys administered to nationally representative samples of 416 pediatric (Peds), 424 family medicine (FM) and 432 general internal medicine (GIM) physicians before (pre-survey, 7/2009-10/2009) and after (post-survey, 3/2010-6/2010) the 2009-2010 influenza season. Results: Response rates were 76% (pre-survey) and 69% (post-survey). On the pre-survey, almost all physicians reported being very/somewhat willing to provide pH1N1 in their offices (Peds 96%, FM and GIM 98%); post-survey, most reported administering pH1N1 when available (Peds 94%, FM and GIM 85%). Parental concern about safety of pH1N1 was the greatest perceived barrier in both the pre- (71%) and post- (72%) surveys. Physician concern about safety was a reported barrier for 62% of physicians in the pre- but only 12% in the post-survey. Most physicians reported having to cancel vaccination clinics due to delays or interruptions in the supply of pH1N1 (Peds, 68%, FM 51%, GIM 47%). The majority reported that demand was higher for pH1N1 than for seasonal vaccine in a typical year (adult patients 66%, children 79%). Conclusions: Compared with physicians, patient and parent concern regarding safety of pH1N1 was a consistent issue during the 2009-2010 influenza season. Many providers cancelled influenza vaccination clinics due to interruptions or delays in vaccine supplies. A large majority of physicians ultimately reported delivering the novel vaccine in a pandemic setting. Such information will be useful in the event of another pandemic or other emerging infectious disease.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
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    ABSTRACT: Background: School-level absenteeism data is used by districts to determine school funding, by public health officials for infectious disease surveillance, and by researchers as an outcome measure. Despite its use, little is known about variation in absenteeism rates between schools. Since illness due to infection is a common cause of elementary school absences, we hypothesized that schools’ infection control policies (ICPs) are related to differences in absenteeism rates. Purpose: 1) Describe the range of absenteeism rates between elementary schools. 2) Determine whether differences in rates are related to school characteristics, including ICPs. Methods: Absenteeism data collected by the Utah Department of Health for two school years (9/07-5/09) were analyzed. School characteristics were obtained from the Utah State Office of Education. Information about ICPs, practices, and resources was obtained by a 2008 survey of all 557 elementary school principals in Utah. The outcome measure was weekly absences/student-days per school. School characteristics included: location, class size, and percent of students qualifying for free/reduced lunch (F/R lunch). ICPs, practices, and resources included: having written hand hygiene and exclusion policies, availability of hand gel and sinks in each classroom, frequency of surface disinfection, and principals’ attitudes about hand hygiene. We used a generalized estimating equation that adjusted for the correlation induced by having multiple weeks of data for each school to determine whether characteristics and ICPs, practices, and resources were associated with absenteeism. Results: Complete data were available for 87 schools representing 16% of elementary schools and 43% of districts in Utah. The intraquartile range for schools’ annual absenteeism rates was 4.2 to 5.8 absences/100 student-days for 07-08 and 3.0 to 5.6 for 08-09. School characteristics: 59% were urban, median class size was 23 students, and median F/R lunch was 37%. Schools’ ICPs, practices, and resources: 23% had a hygiene policy, 53% had an exclusion policy, 67% had sinks and 33% had hand gel in all rooms, 13% disinfected daily, and 71% of principals agreed that hand hygiene is a priority. Schools with more F/R lunch had higher absenteeism—each 30% increase in F/R lunch was associated with 1 more absence/100 student-days (p = 0.04). Schools with an exclusion policy had fewer absences than those without—4.0 vs 4.6 absences/100 student-days ( p = 0.04). We identified an interaction: absenteeism in schools with an exclusion policy is constant regardless of F/R lunch. However, in schools without an exclusion policy, absenteeism increases as F/R lunch increases. Conclusion: Some elementary school characteristics appear to be associated with differences in absenteeism. ICPs are the only modifiable characteristics identified. Measuring ICPs and their implementation is imprecise and may not reflect what occurs in schools. Prospective study is warranted to determine whether changes in schools’ ICPs can decrease absenteeism.
    2010 American Academy of Pediatrics National Conference and Exhibition; 10/2010
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    ABSTRACT: The feasibility of non-pharmacologic interventions to prevent influenza's spread in schools is not well known. To determine the acceptability of, adherence with, and barriers to the use of hand gel and facemasks in elementary schools. Intervention: We provided hand gel and facemasks to 20 teachers and their students over 4 weeks. Gel use was promoted for the first 2 weeks; mask use was promoted for the second 2 weeks. Outcomes: Acceptability, adherence, and barriers were measured by teachers' responses on weekly surveys. Mask use was also measured by observation. The weekly survey response rate ranged from 70% to 100%. Averaged over 2 weeks, 89% of teachers thought gel use was not disruptive (week 1--17/20, week 2--16/17), 95% would use gel next winter (week 1--19/20, week 2--16/17), and 97% would use gel in a pandemic (week 1--20/20, week 2--16/17). Averaged over 2 weeks, 39% thought mask use was not disruptive (week 1--6/17, week 2--6/14), 35% would use masks next winter (week 1--5/17, week 2--6/14), and 97% would use masks in a pandemic (week 1--16/17, week 2--14/14). About 70% estimated that their students used hand gel ≥ 4 x/day for both weeks (week 1--14/20, week 2--13/17). Students' mask use declined over time with 59% of teachers (10/17) estimating regular mask use during week 1 and 29% (4/14) during week 2. By observation, 30% of students wore masks in week 1, while 15% wore masks in week 2. Few barriers to gel use were identified; barriers to mask use were difficulty reading facial expressions and physical discomfort. Hand gel use is a feasible strategy in elementary schools. Acceptability and adherence with facemasks was low, but some students and teachers did use facemasks for 2 weeks, and most teachers would use masks in their classroom in a pandemic.
    Influenza and Other Respiratory Viruses 07/2010; 4(4):223-9. · 1.47 Impact Factor
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    ABSTRACT: Identify parental beliefs and barriers related to influenza immunization of school-aged children and acceptance of school-based influenza immunization. We conducted a cross-sectional survey of parents of elementary school-aged children in November 2008. Outcomes were receipt of influenza vaccine, acceptance of school-based immunization, and barriers to immunization. Response rate was 65% (259/397). Parents reported that 26% of children had received the vaccine and 24% intended receipt. A total of 50% did not plan to immunize. Factors associated with receipt were belief that immunization is a social norm (adjusted odds ratios [AOR], 10.8; 95% CI, 2.8-41.8), belief in benefit (AOR, 7.8; CI, 1.8-33.8), discussion with a doctor (AOR, 7.0; CI, 2.9-16.8), and belief that vaccine is safe (AOR, 4.0; CI, 1.0-15.8). A total of 75% of parents would immunize their children at school if the vaccine were free, including 59% (76/129) who did not plan to immunize. Factors associated with acceptance of school-based immunization were belief in benefit (AOR, 6.1; 95% CI, 2.7-14.0), endorsement of medical setting barriers (AOR, 3.7; 95% CI, 1.3-10.3), and beliefs that immunization is a social norm (AOR, 3.3; 95% CI, 1.4-7.6) and that the child is susceptible to influenza (AOR, 2.6; 95% CI, 1.2-5.7). Medical setting barriers were competing time demands, inconvenience, and cost; school barriers were parents' desire to be with children and competence of person delivering the vaccine. School-based immunization programs can increase immunization coverage by targeting parents for whom time demands and inconvenience are barriers, demonstrating that immunization is a social norm, and addressing concerns about influenza vaccine benefit and safety.
    The Pediatric Infectious Disease Journal 03/2010; 29(8):751-5. · 3.57 Impact Factor

Publication Stats

127 Citations
61.56 Total Impact Points

Institutions

  • 2012–2014
    • Children's Hospital Colorado
      Aurora, Colorado, United States
  • 2007–2013
    • University of Colorado
      • Department of Pediatrics
      Denver, Colorado, United States
  • 2007–2012
    • University of Utah
      • • Department of Pediatrics
      • • Department of Biomedical Informatics
      Salt Lake City, Utah, United States