The Difference One Nurse Makes: Chiricahua’s Innovative Approach to Increasing Vaccinations


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MAY 13, 2024
Increasing the number of HPV vaccinations by more than 20%, eliminating the missed opportunity of vaccinating more than 1,500 children and adults, and delivering more than 2,000 immunizations that would otherwise not have been administered – these are accomplishments many health providers would love to achieve. Chiricahua Community Health Centers (Chiricahua) did it in one year – and by adding just one nurse. The Global HPV Consortium partner shared its best practice at a recent Consortium webinar.

Covering a large section of southeastern Arizona, and running 100 miles along the border with Mexico, Chiricahua has the Herculean task of providing care to about 25% of the population of Cochise County. Larger than 80 U.N.-recognized countries and bigger than the states of Rhode Island and Connecticut combined, the region and catchment area is more populated than 40 countries and includes military bases as well as seasonal and migrant farm worker settlements. In recent years, the area has also been home to the busiest U.S. border crossing for asylum seekers.

To provide almost 140,000 patient encounters each year in this environment, Chiricahua runs eight mobile medical and mobile dental clinics, 14 fixed-site medical, dental, and behavioral health clinics, as well as Chiricahua-owned and -operated pharmacies. Chiricahua Pharmacies are co-located at clinical sites to ensure ease of access for patients, filling more than 188,000 prescriptions in 2023.

With 80% of its 33,000+ patients living in federally defined poverty, Chiricahua is similar to other members of the Global HPV Consortium in its implementation of innovative, cost-effective policies and practices that integrate services. HPV prevention and cervical cancer elimination through HPV vaccination (primary prevention) plus screening and treatment (secondary prevention) are a priority.

Like most health systems around the world, Chiricahua noticed significant decreases in all immunizations during and after the pandemic. By 2022, pediatric vaccination coverage had dropped from 48% to just 35%. To catch up, Chiricahua decided to pilot a program to offer vaccinations to those who came in for appointments at its dental clinics.

“Managing the health needs of this diverse patient population requires constant innovation.” says Emily Harris, MPH, Chiricahua’s director of Community Health.

Emily Harris, director of Community Health at Chiricahua, presents a research poster on the dental clinic vaccination program outcomes.

After a patient survey determined there would be interest, the vaccine and dental teams created a plan. The only addition: one nurse, who would contact patients before their appointment, secure the needed vaccines if patients agreed, and provide immunizations on site. The nurse also follows up with patients if they declined vaccinations at the dental clinic to schedule separate vaccine appointments.

The pilot began in May of 2023. A year later, more than 2,000 vaccines have been administered in Chiricahua Dental Clinics to more than 1,500 children and adults. About half of all patients offered the vaccines took advantage of the dental clinic opportunity. The innovative project won Chiricahua a “Big Shot” award from the Arizona Partnership for Immunization for groundbreaking efforts that “marked a significant milestone in healthcare delivery.”

“Offering vaccines within our dental facilities helps to eliminate some of the barriers a patient may face to receive vaccines, such as making multiple appointments or taking additional time off from work,” says Chiricahua’s Vaccine Program manager Kelsey Vincent, a registered nurse.

Patients agree. “They tell me it’s fantastic to be able to get vaccines here, that it’s like a one-stop shop!” says Kim Fruth, the LPN who administers vaccines in the dental clinics every day.

Chiricahua shares the story of the dental clinic so others can learn from its experience. “When I first heard about the Global HPV Consortium, it just really jumped out at me how important this Consortium would be for sharing practices that work,” says Dennis Walto, Chiricahua’s chief external affairs officer. “Chiricahua is very eager to both contribute and to learn about what’s happening globally. The goal is always how we can better serve our patients.”

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