REDUCING COVID VACCINE REFUSAL IN A POPULATION OF ELDERLY VETERANS: A QUALITY IMPROVEMENT PROJECT

ABSTRACT

BACKGROUND: Home Based Primary Care (HBPC) is a multidisciplinary program in the VA which provides primary care in the patients' homes. There are some patients in the Puget Sound HBPC program who have refused the Covid vaccine, which increases their risk of serious illness and death. This Quality Improvement Program was intended to increase uptake of the Covid vaccine in Veterans who initially refused it. METHODS: Planned Activity We will ask questions, reserve judgment, share the science, be honest and supportive, and model behavior. SMART goal (specific, measurable, achievable, results-focused, and time bound) Reduce refusals of Covid vaccine by 50% in 4 months. A spreadsheet was created in a secure drive in which the nurses documented patients who refused the Covid-19 vaccine and the reason the patient gave for refusing. The HBPC team met monthly for four months to document any patients who agreed to be vaccinated and reasons for agreeing, and to discuss interventions that were well-received. RESULTS: The patient census in the HBPC program at the start of the project was 458 patients. 422 patients (92%) were vaccinated during the initial vaccination effort by HBPC. 36 patients refused the vaccines against Covid-19 (8%). Among those who refused vaccination, lack of trust of the government or the vaccine itself were the most common reasons, with smaller numbers endorsing conspiracy theories or citing political identification. Over the course of our project a total of four patients died (11.1%). Two patients died of Covid (5.5%), one died of cancer (2.8%) and one died of a PEA arrest (2.8%). A total of 6 patients (16.7%) accepted vaccination over the course of the project. 26 patients (72.2%) remained unvaccinated. Two patients accepted because being vaccinated was a requirement;one to travel and one to be accepted for an inpatient respite stay. One patient was vaccinated after he received information from a professional society which recommended vaccination. Two patients accepted vaccination (5.5%) due to education from the HBPC team and from family. One patient was vaccinated during an inpatient stay in a community hospital. CONCLUSIONS: Vaccination against Covid-19 was widely accepted in this patient population of elderly Veterans with multiple medical problems, with a vaccination rate of 92%.Among those who refused vaccination, lack of trust of the government or the vaccine itself were the most common reasons, with smaller numbers endorsing conspiracy theories or citing political identification. Our intervention did not meet the goal of increasing vaccine uptake by 50%. Few patients who initially refused vaccination changed their minds. There is very little medical research about interventions for vaccine hesitancy, with much of the current published literature on this topic consisting of expert opinion. The literature that is available suggests that some interventions can be counterproductive. Mandates may be effective because individuals are not required to change their minds.