Photo: Borinquen Health Center in Miami, FL
Written by Erica H. Weiss, MPH, MSUP, Sr. Health Writer, NACHC in collaboration with NACHC’s Public Health Integration team.
The total number of hospitalizations from seasonal respiratory illness is expected to be higher this fall than any year before the pandemic UNLESS we can take advantage of available lifesaving vaccines. For the first time in U.S. history, we have updated vaccines for all three major respiratory viruses – COVID-19, flu, and RSV.
Health centers around the country are getting ready to administer these powerful vaccines, but the pull of mistrust remains a real obstacle. Just last year, 75% of people in the U.S. declined the bivalent booster. (Meanwhile, it was shown to reduce hospitalization by 81% and death by 86%.)
What are Health Centers Doing about Vaccine Non-Compliance?
Thirty to forty Health Centers, PCAs and HCCNs around the country joined NACHC’s Learning Communities to implement impactful strategies for adult vaccine uptake. Strategies like improving workflows by applying the National Vaccine Advisory Committee’s (NVAC) Standards for Adult Immunization Practice, working with care extenders like pharmacists and Community Health Workers (CHW) who become Vaccine Ambassadors to engage high-risk patients, harmonizing service delivery with data collection, and other quality improvement efforts.
“You know what works? Personal communication. When health center staff approach patients with empathy, positivity, patience, and encouragement for vaccines, it seems to work.” observes Rocio Payne, MHA, RN-BC, Clinovations Government + Health. “Patients trust their health center care teams. Health center staff can cut through the skepticism and misinformation because they remain a relatable and reliable source for good health information.”
A-Ha Moments from Chart Audits
Mini-interventions based on the Standards for Adult Immunization Practice (Assess, Recommend, Administer/Refer, Document) were conducted in 12 health centers, starting with manual chart audits and adjustments to adult vaccination workflows. At Neighborhood Health, Jessica McKee, Director of Nursing noted, “The first chart audit showed 1 out of 10 patients declined vaccines. When the nurse reinforced that providers must document all declined vaccines (previously not recorded), the staff were surprised to see how many patients were opting out. After we focused on documentation, the second chart audit showed 5 out of 10 patients declined.” To directly address this problem, providers began to reengage patients with open communication.
At Camillus Health Center, the Clinical Outcomes Manager, Ana Velez, noted the influx of migrants from the Caribbean and South America to their health center “come with hypertension, depression, diabetes, and asthma – all things that are prevalent in our patient population. As we see this, we know additional preventive education and vaccine awareness has become paramount.” Ana and Samuel Carabajal, Vaccine Program Manager, Bay Area Community Health share the “a-ha” realization that “each patient contact, regardless of the visit, presents an opportunity to close care gaps for vaccines.”
The Magic Touch of Vaccine Ambassadors
Another highly impactful strategy to reduce patient mistrust and misinformation has been witnessed through the Vaccine Ambassador Project led by NACHC, the CDC, and the National Health Care for the Homeless Council. This program engaged 20-30 health centers across the U.S. that recruited Vaccine Ambassadors to chip away at vaccine inequity among people experiencing homelessness, substance use disorder, and sex work. The magic touch of these Vaccine Ambassadors led to nearly 32,000 high-risk patients gaining vaccine education and uptake.
Noel Malone is a Vaccine Ambassador in St. Louis. She explains, “I was a foster child from age 5-21, but now I’m a CHW and Vaccine Ambassador because I have a deep desire to connect all people with the resources they need.” She helps people feel more comfortable with vaccines and other health center services – and that really does save lives.
How to Improve Vaccine Rates at Your Health Center: Adult Immunizations – NACHC
- Put the Standards of Adult Immunization into practice: Watch Lining Up the Shots – Five, short, 3 to 5-min videos help health center care teams effectively apply the Standards (Assess, Recommend, Administer/Refer, Document)
- Consider starting a Vaccine Ambassador Program: Use the 10 Tips to Start a Vaccine Ambassador Program at your health center
- Remind patients who are not insured or under-insured they have access to free vaccines through the Bridge Program