ABSTRACT
BACKGROUND: Despite COVID-19 vaccines' demonstrated effectiveness in mitigating COVID-related hospitalizations and death, large numbers of Americans, including U.S. veterans, have not completed the primary vaccine series or the third/booster dose. The Veterans Health Administration (VHA) is the largest integrated health care system in the U.S. Identifying subgroups of veterans that have not completed COVID-19 vaccination and booster/third doses may inform targeted interventions to decrease disparities and promote vaccine completion. METHODS: We included veterans enrolled at VHA facilities from Jan 1, 2021 (first COVID-19 vaccinations available for highest risk veterans per CDC guidelines) through December 22, 2021. The VA COVID-19 Shared Data Resource was linked to the Corporate Data Warehouse to provide vaccination and other COVID-related clinical information, as well as demographic and social determinants data. The main study outcome was completion of the COVID-19 primary vaccine series (two doses of either mRNA vaccine or one dose of the viral vector vaccine). Secondary outcome was completion of the booster or third dose among eligible veterans. Univariate descriptive statistics determined the proportion of veterans completing vaccination by subgroup of interest;relative risks calculated statistical significance. RESULTS: Of 6,235,555 veterans, 9.5% were women;mean age was 62.9 years (+/-16.8 years);31.2% were of non-White racial/ethnic minority groups;6.7% were Hispanic. Of these, 61.7% completed primary vaccination series. Primary vaccination rates were significantly lower in younger veterans ≤ 49 years (47.2%) compared to those >50 years (67.7%). In addition, lower primary vaccination rates were found in women vs. men (57.1% vs. 62.5%);those residing in highly rural vs. urban locations (53.9% vs. 64.5%);Native Americans (56%) compared to Black/African American (64.8%), Hispanic (63.9%) or White (61.6%) veterans;those reporting food insecurity vs. not (54.9% vs. 64.3%);housing insecurity vs. not (51.6% vs. 65.1%);having had a positive vs. negative COVID-19 test prior to vaccination (45.5% vs. 71.6%);and not assigned a primary care team vs. assigned (45.2% vs. 64.5%), (all pvalues < 0.001). Of 3,672,322 eligible veterans, 33.5% received their booster/ third doses as of 12/22/21. Subgroups at risk for not having received booster/ third doses were the same as for the primary series, with the youngest veterans (18-49 years) having the lowest rates of booster/third doses compared to veterans > 50 years (16.1% vs. 36.9%). CONCLUSIONS: Based on VA data, substantial proportions of veterans remain unvaccinated-or under-vaccinated, especially younger veterans, women, Native Americans, those with food or housing insecurity, prior COVID-19, and those not assigned to primary care. Impactful interventions, including health care staff encouraging vaccine completion among more vulnerable subgroups, are needed to avoid further disparities related to adverse COVID19 outcomes.
ABSTRACT
Methods: Target enrollment in the wHOPE (Whole Health Options in Pain Education) trial is 750 veterans with moderate to severe chronic pain from five geographically diverse VA facilities across the U.S. We are creating an inclusive and generalizable sample through few exclusion criteria, over-sampling and stratified randomization, prioritizing women veterans and those prescribed opioids, while closely monitoring racial and ethnic diversity. The primary aim of the trial is to determine whether a Whole Health Team (WHT) (interdisciplinary Whole Health/integrative pain team) is superior to Primary Care Group Education (PC-GE, abbreviated group Cognitive Behavioral Therapy for Chronic Pain), and whether both are superior to Usual Primary Care (UPC) in decreasing pain interference and secondarily, in improving quality of life and use of non-pharmacological modalities to manage chronic pain. An implementation evaluation and budget impact analysis will provide information about feasibility, maintenance, and sustainability. Descriptive statistics characterized wHOPE study participants including COVID-19-related impacts. Results: To date, of 248 randomized participants, mean age is 60.2 (SD+/-12.3) years;39% women;23% Black or African American and 9.2% Hispanic/Latinx;27% were prescribed opioids. Roughly half endorsed moderate to severe depression, moderate PTSD symptoms, and 58% reported sleep difficulties. Roughly 20% engaged in hazardous drinking and 10% problem drug use. At baseline, veterans reported high rates of non-pharmacological and CIH pain management, e.g., mindfulness (42%);spinal manipulation (32%). As a result of COVID, wHOPE participants reported worsening: mental and emotional health (73%);access to healthcare (59%);pain intensity (48%) and use of tobacco (44%) and cannabis products (36%). Background: To conduct a pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care. Conclusion: This ongoing multi-site pragmatic trial in a diverse group of veterans with chronic pain and high rates of comorbidity indicates high baseline use of CIH and substantial negative COVID-related impacts.
ABSTRACT
Objective: The Veterans Health Administration is implementing Whole Health cultural transformation to equip Veterans with tools to take charge of their health. The onset of COVID-19 created a need for innovation in virtual care delivery of Whole Health education. Methods: The San Francisco VA adapted a Whole Health Passport Group from an in-person workshop series to a drop-in workshop series on a Web-Ex platform cofacilitated by a veteran peer support specialist and clinician. Veterans learned about the eight dimensions of Whole Health: Working the Body, Surroundings, Personal Development, Food & Drink, Recharge, Family, Friends & Co-workers, Spirit & Soul, Power of the Mind. Each virtual workshop began with a mindful moment and meet-&-greet to foster community and included Whole Health education. Each workshop culminated in group members creating a personalized health plan comprised of SMART (specific, measurable, actionable, realistic, time-bound) goals based on each veteran's personal values. To pilot the Whole Health Passport Group, two veterans were recruited from the Whole Health coaching program. Qualitative feedback was solicited from participating veterans through brief, informal interviews at the last workshop. Results: The two enrolled veterans successfully participated in the pilot via phone and video, respectively. One completed all eight workshops via phone;the other completed 7 workshops via video. The veteran attending the full cycle described the program as something that helps with our humanity and everything that we have to do in our personal lives. He added: It's important that we continue to grow, and this is helping us do that. Tools discussed enhance skills of the individual personally, socially and professionally. Conclusion: Based on limited but positive observations, the Whole Health Passport Groups will leverage the virtual platform to expand and to serve veterans across Northern California. Future steps include further Quality Improvement evaluation and diversification of referral pathways to reach more veterans.
ABSTRACT
Objective: This study investigated whether low vitamin D levels are independently associated with COVID-19-related hospitalization and mortality. Methods: A retrospective cohort of 5,634 COVID-19+ patients with recent Vitamin D labs receiving care at US Department of Veteran Affairs (VA) health care facilities from February 20, 2020 to November 8, 2020, was identified. Vitamin D level was ascertained using the 25-hydroxyvitamin D3 or D2+D3 test result within 90 days preceding the index positive COVID-19 test. Study outcomes were: (1) inpatient hospitalization requiring isolation and (2) 30-day mortality among those hospitalized. Poisson Generalized Linear Models with robust errors and adjusted for sociodemographics and comorbidities were used to estimate outcome probabilities conditional on the log of Vitamin D levels. Results: Of 5,634 veterans with a positive COVID-19 test, 707 (12.6%) were female, mean age was 62.5 (SD +/-15.1);1,920 (34.1%) identified as non-White, and 623 (11.1%) as Latinx. Low vitamin D levels (<20 ng/ml) were found in 794 (14.1%) and 1,162 (20.6%) were hospitalized for COVID-19 infection. After adjusting for all covariates, the probability of hospitalization was 23.7% for those with Vitamin D levels of 15ng/ml, but decreased to 19.8% for patients with higher vitamin D levels of 40 ng/ml, [Adjusted Relative Risk (ARR)=1.20 (1.06, 1.36, p=.004)]. Among 1,162 hospitalized patients, 186 (16.0%) died within 30 days. The adjusted mortality rate for patients with Vitamin D levels of 15 ng/ml was 22.3% and decreased to 14.4% for patients with higher vitamin D levels of 40 ng/ml, [ARR=1.55 (1.11,2.18, p=.011)]. Conclusion: Vitamin D level may have a role in predicting COVID-19-related hospitalization and mortality;larger trials are needed to determine if vitamin D supplementation improves COVID-19-related clinical outcomes.