An immunization quality improvement learning collaborative in the college health setting.

OBJECTIVE: To increase administration of influenza (flu), human papillomavirus (HPV) and meningococcal serogroup B (MenB) vaccinations to students at college student health centers (SHCs). PARTICIPANTS: Improvement teams from 45 US-based SHCs. METHODS: Teams participated in a 7-month virtual learning collaborative to implement immunization delivery best practices at their SHCs. A pre-post-intervention design was used to compare vaccination coverage in May 2017 to May 2018 among students who were unvaccinated at the start of the academic year. RESULTS: Data were compared from 29 SHCs and 152,648 students (2017) and from 18 SHCs and 122,315 students (2018). Percent of newly vaccinated students increased for ≥1 dose of flu vaccine by 14.3 percentage points to 32.3% (p < .01), ≥1 dose of HPV vaccine by 3.9 points to 7.8% (p < .05) and ≥3 doses of HPV vaccine by 0.7 points to 1.5% (p < .05). CONCLUSIONS: Participating in a learning collaborative may help SHCs improve vaccination delivery.

How colleges intervene to increase student body vaccination coverage.

OBJECTIVE: The interventions colleges use to help students be compliant with vaccinations is unknown. This study describes colleges' use of practices consistent with Centers for Disease Control and Prevention (CDC) recommendations to encourage student body vaccination. PARTICIPANTS: Participants were a convenience sample of 136 student health center (SHC) administrators from colleges across the U.S. METHODS: An online survey assessed SHCs' use of various practices, policies and services to improve student body vaccination coverage. RESULTS: There was wide variability in use of evidence-based interventions overall and with respect to specific vaccinations. While most SHCs (92.7%) coordinated vaccination outreach events on campus, only half (50%) accessed an immunization registry to verify vaccination histories. While 88.6% requested student vaccination histories for MMR, only 39.7% requested it for human papillomavirus (HPV). CONCLUSIONS: The discrepancies in SHC implementation of interventions to increase coverage of the recommended vaccinations for students suggest that helping colleges expand their capacity to intervene may decrease coverage rate disparities.

Serogroup B meningococcal vaccination practice patterns on college campuses.

BACKGROUND: Most Neisseria meningitidis involved in invasive disease among American college students express serogroup B antigen. The Advisory Committee on Immunization Practices (ACIP) recommends healthcare providers (HCPs) share clinical decision making with patients to determine individual value of meningococcal serogroup B vaccination (MenB) rather than routinely recommend vaccination as with the meningococcal A,C,W,Y vaccine (MenACWY). This study examines the attitudes and practices of HCPs working in college student health centers (SHCs) regarding the recommendation and administration of MenB to students. METHODS: The study was conducted as an online and phone survey of SHC HCPs from a sample of colleges across the United States between May 2017 and July 2018. Items compared college SHC policies and practices for MenB to those for MenACWY. It also assessed perceived barriers to and facilitators of MenB delivery to students. RESULTS: Among the 147 respondents, almost 50% more reported their SHC stocked and administered MenACWY (54.1%) than MenB (37%) (p = .004). Almost five times as many colleges required their students receive MenACWY as MenB (53.5% vs. 10.5%, p < .001). A greater percentage requested students to submit records for MenACWY than MenB (77.3% vs. 46.9%, p < .001), and over three times as many tracked student-body coverage rates for MenACWY than MenB (55.6% vs. 15.8%, p < .001). Nearly three quarters of respondents estimated their college's student body MenB coverage rate to be ≤ 10% or were unable to provide any estimate. Factors perceived by over half of the participants as moderate to extreme barriers to administering MenB included high upfront costs for SHCs to purchase and stock MenB (68.7%), and high out-of-pocket costs for students to receive it (82.8%). CONCLUSIONS: A minority of college SHCs require, offer or track Men B vaccination on their campuses. Financial concerns are common barriers to SHCs' stocking and administering MenB to students.

Computer self-administered screening for substance use in university student health centers.

Objective: To characterize the prevalence of tobacco, alcohol, and drug use and the acceptability of screening in university health centers. Participants: Five hundred and two consecutively recruited students presenting for primary care visits in February and August, 2015, in two health centers. Methods: Participants completed anonymous substance use questionnaires in the waiting area, and had the option of sharing results with their medical provider. We examined screening rates, prevalence, and predictors of sharing results. Results: Past-year use was 31.5% for tobacco, 67.1% for alcohol (>4 drinks/day), 38.6% for illicit drugs, and 9.2% for prescription drugs (nonmedical use). A minority (43.8%) shared screening results. Sharing was lowest among those with moderate-high risk use of tobacco (OR =0.37, 95% CI 0.20-0.69), alcohol (OR =0.48, 95% CI 0.25-0.90), or illicit drugs (OR =0.38, 95% CI 0.20-0.73). Conclusions: Screening can be integrated into university health services, but students with active substance use may be uncomfortable discussing it with medical providers.

Call to action: Better care, better health, and greater value in college health.

It is time for action by leaders across higher education to strengthen quality improvement (QI) in college health, in pursuit of better care, better health, and increased value - goals closely linked to students' learning and success. The size and importance of the college student population; the connections between wellbeing, and therefore QI, and student success; the need for improved standards and greater accountability; and the positive contributions of QI to employee satisfaction and professionalism all warrant a widespread commitment to building greater capacity and capability for QI in college health. This report aims to inspire, motivate, and challenge college health professionals and their colleagues, campus leaders, and national entities to take both immediate and sustainable steps to bring QI to the forefront of college health practice - and, by doing so, to elevate care, health, and value of college health as a key pathway to advancing student success.

Primary care screening of depression and treatment engagement in a university health center: a retrospective analysis.

OBJECTIVES: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. PARTICIPANTS: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between January and April 2006. METHODS: A standardized 2-tiered screening approach for an inception cohort of students utilizing primary services. Primary care providers were trained to triage students with depressive symptoms. RESULTS: Six percent of participants had clinically significant depressive symptoms (CSD). Severe depressive symptoms were found in less than 1.0% of participants. Male rates of severe depressive symptoms were more than double that of females. Only 35.7% of untreated depressed participants started treatment within 30 days following identification. CONCLUSIONS: Systematic primary care depression screening in a college health center is a promising approach to identify untreated students with depression. More study is needed to improve rates of treatment engagement.

Can interactive skills-based seminars with standardized patients enhance clinicians' prevention skills? Measuring the impact of a CME program.

OBJECTIVE: Communication skills are crucial for high-risk behavior screening and counseling. Practicing physicians have limited opportunities to improve these skills. This paper assesses the impact of a continuing medical education (CME) program for Student Health Center clinicians that targeted communication skills, screening practices and patient satisfaction. METHODS: Program evaluation included pre- and post-objective structured clinical examinations (OSCE's), chart review, and provider and patient satisfaction surveys. Data were analyzed using paired t-tests and ranked sum tests. RESULTS: OSCE scores (n=15) revealed significant improvements in communication skills overall (p=0.004) and within specific domains (data gathering: p=0.003; rapport building: p=0.01; patient education: p=0.02), but no change in case-specific knowledge (p=0.1). Participants (n=14) reported high satisfaction with program methods (mean=4.6/5) and content (mean=4.7/5), 70% planning to alter their clinical practice. Chart audits (pre=96, post=103) showed increased screening for smoking (RR 1.65, p=0.03), depressed mood (RR 1.40, p=0.04), anhedonia (RR 1.47, p=0.01), sexual activity (RR 1.73, p=0.002) and drinking (RR 1.77, p=0.04). Sampling of satisfaction among participants' patients (pre n=689, post n=383) detected no increase in already high baseline satisfaction. CONCLUSION: This curriculum improved clinicians' relevant skills and screening behavior. PRACTICE IMPLICATIONS: Skills-oriented CME can improve clinicians' communication skills and screening and counseling practices.