Since the COVID-19 vaccine became available to UR Medicine patients in January, URMC has made progress toward equitable distribution for people of color, people living in poverty and other people who lack access to health care. But there’s much more work ahead.
The Primary Care Network selected Manhattan Square Family Medicine for its first vaccine clinic Jan. 15 to prioritize patients living in underserved areas of the City of Rochester. Days later, URMC added a second community clinic at Saunders Research Building. But it soon became clear in Rochester and around the U.S. that people of color were receiving vaccine at a lower rate than white people.
Expanding outreach to underserved patients and people of color is starting to make a difference, said John Clark, Regional Administrative Director for Primary Care.
“In February, 18.5 percent of Manhattan Square patients receiving vaccination were Black; currently Black people make up 24 percent of those vaccinated at the clinic.”
The work to improve equity continues:
Outreach to Primary Care patients about community clinics
MyChart is the most efficient way to reach patients eligible for vaccine, but many Primary Care patients living in poverty don’t have computer access. Primary Care put more resources into phone outreach and e-mail for patients who have accounts they can access on their mobile phones.
“We distributed call lists to all of our practices in addition to having our central call center staff make the calls, using targeted ZIP codes provided by Common Ground Health,” Clark said. “That significantly increased the volume of outbound calls. And when the city announced early scheduling at the Hawkeye site for people in specific ZIP codes, we sent about 60,000 emails and a few thousand phone calls to reach our patients living in those neighborhoods.”
It’s difficult to measure the impact of that, but Clark noted that the city had 30,000 doses for the Hawkeye site and scheduled 15,000 people in the first week. “I believe we contributed to that phenomenal result.”
Consultation with a panel of ethicists for decision-making
A panel of medical ethicists led by Margie Shaw, Associate Professor, Law and Bioethics, helps Primary Care balance the need for equity with the state’s mandate that weekly vaccine allocations are fully distributed within seven days.
Primary Care doesn’t know how much vaccine it will receive until the Sunday before a clinic, leaving little time to schedule patients. It could quickly fill slots via MyChart, but miss reaching underserved patients. On the other hand, telephone outreach to them takes longer, which risks leaving slots unfilled.
“The ethicists give us practical suggestions to work toward equity while meeting the state’s expectation that we distribute all of our allocation every week,” Clark said. “For example, if we have five days to recruit patients, we consistently work by phone to reach people not on MyChart and by day 3 if we haven’t made headway, the ethicists recommend backfilling that week’s clinic appointments with patients via MyChart.”
“It is important that the process for allocating scarce resources promote certain values, including transparency, inclusiveness, consistency, and accountability,” Shaw said. “A fair system engenders trust and promotes our institutional values. The Finger Lakes COVID-19 Vaccine Hub leadership has focused on fairness from the beginning and continues to prioritize our most underserved populations while ensuring compliance with state mandates.”
Providing clinical support for pop-up clinics
Because the overall patient base in the Primary Care Network is disproportionately white, people of color will continue to be underrepresented in its vaccination rolls even with significant outreach. Vaccination outside the primary care patient base to the wider community is one way to address that, so Primary Care is teaming up with community agencies for pop-up clinics.
At one-day, pop-up vaccination sites for underserved patient populations, Primary Care clinical staff deliver vaccine; the community partner provides the venue and manages clinic promotion and patient scheduling.
UR Medicine and Rochester Regional Health take turns staffing clinics. URMC teams have staffed pop-up clinics in Rochester to serve Black and Latino communities; older adults; and refugee populations.
“Typically, the clinical lead provides six vaccinators, at least one provider, and a few staff doing data entry,” said Wendy Parisi, Director for URMC Safety-Net and Program Support Office, and Operations Lead for the Finger Lakes COVID-19 Vaccine Hub. “It’s a terrific way for a clinical group to team-build, serve our community, and help combat the pandemic.”
“This is a great example of engaging with the community to build trust,” said Adrienne Morgan, Ph.D., University of Rochester associate vice president for Equity and Inclusion, and senior associate dean for equity and inclusion for the School of Medicine and Dentistry. “I hope this work builds momentum and expands expectations and bandwidth for addressing the inequities that COVID has intensified. We need to keep working hard to remove systemic barriers to healthcare.”
Clark said PCN practices want to increase their involvement in vaccine distribution equity by staffing more pop-up clinics.
“We’re optimistic in coming months that we will be able to demonstrate we can do even more than what we’re doing now.”
Mobile vaccination clinics
Patients with intellectual and developmental disabilities and complex, lifelong medical conditions frequently lack adequate access to essential health care, and COVID vaccine is no exception.
Ensuring that they have vaccine access “is central to the mission of the Complex Care Center – to bring essential health care to patient populations that face significant barriers,” said Tiffany Pulcino, M.D., M.P.H., founder of the Complex Care Center and Chief of the Division of Transitional Care Medicine in Medicine and Pediatrics.
Pulcino and her team worked with several community agencies to set up mobile vaccine clinics for them throughout the community.
To date, more than 2,000 patients have been vaccinated, as well as staff members at agencies who care for them.
“We have completed all of the group homes of Monroe County and now are vaccinating those with IDD who live in the community but attend congregate day settings like day hab, vocational programs, school-based programs, and family care settings,” Pulcino said.
“The partnerships that Complex Care Center has formed with community organizations such as Heritage Christian, Hillside Children’s Services and others was instrumental in getting the clinics set up so quickly, and vaccinating patients and staff members efficiently.”
Across the board, vaccine distribution has been a complex and rapidly changing frontier. Soon after health care systems launched community clinics for patients, New York State directed them to focus solely on their employees. In recent days the state pivoted back, allowing any vaccine center (with some exceptions) to vaccinate everyone who’s eligible.
“So now that door is open to us again,” Clark said, “and we want to play a lead role in vaccinating our patients and taking vaccine to those who don’t have access to health care.”
“Vaccination,” Clark noted “is a foundational tool for diseases prevention, and this is a core mission for Primary Care. We have many challenges ahead delivering vaccination to those who are hesitant or who face socioeconomic barriers to vaccination, but URMC’s team of vaccination providers, staff and volunteers have accomplished so much in recent weeks. We should be proud of that, as we look for new ways to serve everyone.”
One more way to serve that’s coming soon: Primary Care is developing a mobile clinic that will travel to safety net practices and regional practices to reach those who otherwise might not get the vaccine.
“We’ll take a team of vaccinators, a pharmacist and support staff, along with the vaccine and vaccinate patients at the practice,” Clark said. “It’s another example of taking the vaccine to the people.”