SARAH: And welcome back to the Southeast Ohio Quality Improvement Hub video series. And today I am joined by the one, the only, Crystal Jones, Director of Nursing at the Athens City County Health Department here in Athens, Ohio. We're so happy that you're here. 

CRYSTAL: Thank you for having me. Excited to be here. 

SARAH: We have just had some really amazing discussions in preparation for this to try to get some really good public health information and vaccination information out to our providers in the region. So, maybe we'll start with patients with diabetes. Maybe we start there. Maybe talking about if we have a patient who has diabetes, maybe what vaccines they should get. 

CRYSTAL: That's a great starting point. There are several that we can talk about. 

SARAH: Okay, good. 

CRYSTAL: COVID-19 would be recommended. Staying up to date on that. Hepatitis B. Flu vaccines would be recommended annually for them. There's pneumonia vaccine, which that with diabetes, you would get that at a younger age than the general population would. So that's an important one. RSV vaccine, if you have diabetes, you would get it sooner than the age may be recommended for the general population... which is generally, I believe 60 years or older. Tetanus boosters or the TDAP vaccine, tetanus, diphtheria, and pertussis, would be recommended every 10 years... which is similar to our general population. And then there is the zoster, also known as the shingles vaccine that would be recommended two doses if you are 50 years or older. 

SARAH: Crystal, what if I don't remember? What if I'm the patient and I don't remember if I've had that vaccine? Is there someplace I could go to ask? 

CRYSTAL: So there are a couple options for that. You can check with your provider, or your MyChart. If you are not having success there, you can call the health department. We have access to Ohio Immunix, which is a database in the state of Ohio that houses vaccine information for anyone in the state of Ohio that providers and health departments can report to. 

SARAH: Okay, that's cool.

CRYSTAL: So you could call us at the health department, and we could look into that system if you do not have another option, and then we can review your vaccines and let you know what we have on file with the system and what you might be due for. 

SARAH: That is really cool. I think that's nice because I personally too will sometimes forget, like, "Did I have that? Did I not have it? When did I get my TDAP last?" Right? Like figuring out if I've had that or not. So as far as where people should get their vaccines completed, so how about at the physician's office, pharmacy, health department? How would we navigate that? Like as a patient, how might I navigate that? 

CRYSTAL: If their provider has that, I think that's great to have that at your provider's office. Some insurance plans, there are certain vaccines that they want you to have through a pharmacy so that may kind of guide where you're going. But we also at the health department have these vaccines that we just discussed, and we can provide those if that were another option or resource for you. And we also have some of these vaccines for those that may not have health insurance coverage to provide those at no cost. 

SARAH: I love that. I think that is forgotten a lot. So utilizing the health department, especially for patients who are uninsured or underinsured. 

CRYSTAL: Absolutely.
 
SARAH:I think that's easily forgotten about. So that's excellent. 

CRYSTAL: And it is important to know because some of these vaccines are very expensive, and so it's important to protect our community. 

SARAH: Yeah. I love that. For our providers, so what resources-- I think we're kind of in a time when resources are a little bit more confusing than they used to be in the past. So what resources might you recommend for providers? 

CRYSTAL: So I know we were focusing on people with diabetes. There is the American Diabetes Association has some nice resources. Okay. The American Academy of Family Physicians put out a immunization schedule, and it gives guidelines based on age as well as medical conditions that would be a good reference, and the Centers for Disease Control also provides those. Some of those. 

SARAH: Yes. Just making sure. 

CRYSTAL: And you can always call the health department. 

SARAH: Oh, funny, I just had that on here. I was like, "Wait, it says call Crystal Jones." Oh, that's you!

CRYSTAL: Absolutely. 

SARAH: Maybe not you directly. Maybe not you directly. Maybe calling your local health department and finding out. 

CRYSTAL: Correct. Yes. Health departments are a great resource on immunizations. And so yes, give us a call. 

SARAH: I think so too. I think that's an underutilized resource, and also even for the providers to call if they don't know or to find out. We also had had a great talk earlier about reporting conditions or public health conditions to the health department, I think is also something that this is a great place to discuss that, is having physicians report those public health diseases to the health department. So thoughts on that. 

CRYSTAL: Absolutely. There are certain illnesses that are reportable, and so you can call us. We actually have an after-hours number, so anything that would even be outside of our normal business hours, you can call us, and public health can follow up. For example, if there was a case of measles we need to know immediately so we can start our process to identify contacts and put measures in place to protect our community. 

SARAH: I love that. So the reason this came up is I have a family member who works at the library. And someone had come into the library and asked, and said, "I had heard that there's a case of measles in Athens City. Is this true?" So I told my sister, I said, "Well, I went to the Athens City County Health Department Facebook page and was looking there to see if there was anything reported." So that is where I was looking to see if it had been reported to the health department. 

CRYSTAL: And so if we would have a probable or confirmed case, we would be posting information on our social medias, plus our website, communicating with our partners on what measures needed to be happening and what our process would be for that. 

SARAH: I think that's wonderful. 

CRYSTAL: Yeah, so thank you. 

SARAH: That's so good. If somebody were to get these vaccines, which ones do they get? Do they get them all at once, or do they get them one at a time, or what does that usually look like? 

CRYSTAL: And that can vary from person to person, depending on what they have going on and what their vaccine status is, but people can receive multiple vaccines at once, and sometimes we are doing that. If you think of when we're vaccinating children, they're receiving two, four vaccines at a time. So, that's where it's important to talk to the provider or health department, people experienced with immunizations, that you can receive more than one vaccine at a time. 

SARAH: Okay. That's a great thing to talk about too. I'm also curious, so we had mentioned patients with diabetes. So are there other classes of patients that should be getting their vaccines more frequently? 

CRYSTAL: Individuals or persons that have, sometimes we refer to as chronic disease, thinking of someone with maybe heart disease, lung disease immunocompromised. Those would be some people that may need the vaccine at a different age than what the general population, that when we think of healthy people, that would need them at a different age. And so talking with a provider or public health, we will help guide you on that. 

SARAH: Okay. I really appreciate that. So just in summary, I think our patients with diabetes, the ADA has a really excellent recommendation on vaccine schedules, and you had mentioned the American Academy of Family Physicians. And utilizing your public health department, I think is a really excellent resource for providers, would be a one-stop shop, I think, to answer lots of questions. And don't forget to report these conditions to your health department to keep the public informed. 

CRYSTAL: Yes, we're here for you. 

SARAH: That was my public service announcement. 

CRYSTAL: Thank you. 

SARAH: PSA, the more you know. Crystal, thank you so much for joining us today. This was really helpful. 

CRYSTAL: It was great, and thank you, and please reach out to us if you have questions. We're here for you. 

SARAH: I love that. Thank you so much for joining us for this episode of our Southeast Ohio QI Hub Diabetes video series, and utilize public health.