ABSTRACT
STATEMENT OF PROBLEM/QUESTION: In early 2021, only 14% of vaccine eligible patients of two academic outpatient practices had received at least one COVID-19 vaccine dose;Black patients comprised 16% of all vaccine eligible patients, but only 10% of those vaccinated, while Hispanic patients comprised 13% of all vaccine eligible patients, but only 7% of those vaccinated. DESCRIPTION OF PROGRAM/INTERVENTION: The objective of this study was to rapidly develop and implement an equity-focused outreach intervention that facilitated COVID-19 vaccine appointments in patients who qualified for a vaccine. The intervention aimed to contact Black and Latino adults ≥65 years old, or ≥18 years old with qualifying chronic conditions, who had at least one visit at the practices within the past three years and who had not received or scheduled a COVID-19 vaccination per electronic health records. Using the Plan-Do-Study-Act model, we developed and executed a multipronged outreach intervention consisting of (1) a mailed letter from the patient's physician endorsing the COVID-19 vaccine, (2) a phone call/recall system to remind patients about their eligibility to receive the vaccine, (3) discussions with a vaccine ambassador to answer questions or address hesitancies regarding the vaccines, and (4) real-time facilitation with scheduling a vaccine appointment and information about where in the community to receive or schedule a vaccine. Volunteer callers were recruited and trained in executing all components of the intervention. MEASURES OF SUCCESS: Bi-weekly focus groups were held with callers to identify challenges with implementation. The number of calls made, patients reached and vaccinations scheduled were analyzed weekly. FINDINGS TO DATE: From March 15 to May 28, 2021, 38 callers were recruited and 5058 calls were made as part of our outreach intervention. Of 2794 total patients attempted, 1519 were successfully reached, 746 of whom had already scheduled or received a vaccine (without documentation in the electronic health record). Of the 750 patients who were reached and eligible for the intervention, 129 (17.2%) had a vaccine scheduled by the caller, 72 (9.6%) planned to self- schedule a vaccine and were instructed on how to do so by the callers, and 549 (73.2%) did not want nor planned to have the vaccine scheduled. The weekly proportion of eligible patients scheduled for vaccine decreased over time, starting at 30% and ending at 0% in the 11th week of the intervention, at which point the intervention was stopped. “Low confidence in the vaccine” and “Still contemplating whether to receive the vaccine” were the two reasons most cited for declining or being unsure about receiving the vaccine. KEY LESSONS FOR DISSEMINATION: An equity-focused outreach program to facilitate vaccination scheduling can be rapidly developed and implemented in outpatient primary care practices, but may need to further consider inaccuracies in vaccination status as documented in the electronic records and increase access to accessible vaccinations sites.
ABSTRACT
Studies before the outbreak reported that lecturers' and teachers’ expectancy were observable to the students from their classroom behavior and, in turn, affect the students' educational self-efficacy (ES). Our study was conducted to investigate whether the aforementioned finding still holds in the compulsory online learning environment during the COVID-19 pandemic. Online learning was not the only implication of the social distancing policy during the pandemic, any form of social interactions among university students was affected up to the point that they rely more on social media to obtain social feedback that eventually altered the way they evaluate themselves. Because this phenomenon might lead to the way students develop the sense that they matter to their society societal mattering (SM) we hypothesized that SM would be a stronger predictor of ES than the students’ perception of the educators’ expectancy. Nevertheless, the data we collected from 361 purposively recruited students from universities in Indonesia and Malaysia indicated that their perceptions of teachers’ expectancy were no longer a significant predictor of ES when the social mattering was controlled for. Further implications, limitations, and suggestions are discussed. © 2022, Institute of Advanced Engineering and Science. All rights reserved.
ABSTRACT
Background: Using QI methodology, we aimed to improve the influenza vaccination rates for children in our pediatric GI clinic during the 2018/2019 and 2019/2020 flu seasons. In 2019/2020, compared to the baseline 2017/2018 season, vaccination rates among children increased from 39% to 53% (IBD-inflammatory bowel disease), 42% to 61% (IR-intestinal rehabilitation) and 72% to 83% (LTx-post liver transplant). In the 2020/2021 season we continued the same interventions, but administered vaccinations to private pay patients (pts) in the clinic. Methods: Patient lists were obtained from our IBD, IR, and LTx clinic registries. The IR and LTx clinics each have one provider, while multiple providers treat IBD pts. Our prior QI projects included use of checklists, letters to patients, posters in clinic rooms, and encouragement of use of a multispecialty flu clinic within the building from October to December. Due to the COVID-19 pandemic, this was changed to a drive-up clinic on campus for the same duration this season. Our hepatologist also sees pts at an outreach site where a flu clinic is available within the building and the location remained unchanged from previous years. To improve data accuracy, vaccination rates were calculated via review of pt charts and the Oklahoma State immunization information system (OSIIS). A QI team met prior to the influenza season and during December. Feedback was given to providers, education was provided to staff, and electronic reminders regarding in-house vaccines were sent from January to March. Results: We had significant staffing issues in 2020 which delayed both teaching support staff, and administering vaccines within our clinic until January 2021. During the 2020/2021 influenza season, telemedicine visits made up 50-75% of IBD, 33-50% IR, and <10% LTx appointments. The corresponding vaccine rates were 28%, 44%, and 48%;the majority of which were given from October-December. In 2019/2020, 18 pts, 6 IBD, 3 IR, and 9 LTx, utilized the institutional flu clinic, while only 1 pt with IBD utilized the drive-up clinic in 2020/2021. The number of vaccines given at the hepatology outreach clinic decreased from 6 to 5. 6 vaccines were administered within the GI clinic from January-March. Conclusions: COVID-19 significantly affected the ability to administer vaccines for pediatric pts with IBD, IR, and LTx in our clinics. We observed sharp declines in use of the multispecialty flu clinic, partly due to a change in location as well as accessibility due to decreased in-person visits. Attitudes towards flu vaccinations in a historic pandemic may have altered families' perceptions and increased barriers to vaccination.