Offering COVID vaccine info in emergency rooms gets shots in arms

January 6, 2023 2:10 PM

A recent study found that offering information about COVID-19 vaccines in emergency rooms - including a short video, a one-page handout, and a brief discussion with a doctor or nurse - significantly increased willingness to get vaccinated.

Summary at PubMed: "Broad implementation in EDs [emergency departments] could lead to greater COVID-19 vaccine delivery to underserved populations whose primary health care access occurs in EDs."

Effect of COVID-19 Vaccine Messaging Platforms in Emergency Departments on Vaccine Acceptance and UptakeA Cluster Randomized Clinical Trial at JAMA Network

Earlier work by these researchers (Robert M. Rodriguez, MD; Graham Nichol, MD, MPH; Stephanie A. Eucker, MD, PhD, et al): The Rapid Evaluation of COVID-19 Vaccination in Emergency Departments for Underserved Patients Study: "Comparing patients having and lacking a regular source of medical care and other ED patient characteristics, we assessed COVID-19 vaccine hesitancy, reasons for not wanting the vaccine, perceived access to vaccine sites, and willingness to get the vaccine as part of ED care."

via a Tweet from Bob Wachter: "among patients seen in ERs (many with limited access to care), a brief video followed by a short message from MD or RN led to marked uptick in acceptance of, then taking, Covid vaccine."

posted by kristi (17 comments total)

Seems like a relatively cheap and effective intervention.

I do wonder if the unvaccinated population that turns up in EDs for their primary care is different from the unvaccinated population at large. The intervention which reaches someone unvaccinated because their access to the health system generally is tenuous and fraught may be different from that which reaches somebody who is unvaccinated because they regard accepting vaccination as being forced to admit they live in a society.
posted by praemunire at 2:20 PM on January 6, 2023 [13 favorites]

I wonder how many are people that live in MAGA-controlled homes and this is their only opportunity to get the vaccine.
posted by CoffeeHikeNapWine at 2:41 PM on January 6, 2023 [8 favorites]

No primary care physician
No atheists in foxholes
No family/friend nearby to reinforce anti-vax stance (no one's accompanied by family/friend; healthcare system is completely overwhelmed, what with all the Covid going around)

Thanks for posting, kristi.
posted by Iris Gambol at 2:44 PM on January 6, 2023

Gosh, yes, good stuff. I wonder how much adding urgent-care centers to this style of intervention would help?
posted by humbug at 2:57 PM on January 6, 2023 [1 favorite]

Awaiting an attempt by the MAGAts to make this illegal.
posted by Splunge at 3:24 PM on January 6, 2023 [3 favorites]

Anecdotally, I got my first flu shot as an adult in the fall of 2019 because I saw a bunch of posters in the public health clinic saying I should get a free flu shot even though I was a healthy adult and then they offered the shot to me and I said yes.
posted by aniola at 3:29 PM on January 6, 2023 [18 favorites]

I can see we are all gung-ho about the ER doing yet another function of a basic primary care medical system. This is one of the many reasons why I think the ER in it's current form will not survive. Increasingly they are asked to do more with less covering literally everyone else's ass risk and liability wise.

The next time you ask why someone collapsed in a waiting room or died in a hallway, know it's partly because the ER has been providing primary care and post surgical care. It's designed to do one thing well which is rule out things that will acutely kill you, they do everything else because they simply cannot refuse to see patients.
posted by Leelas at 10:35 PM on January 6, 2023 [11 favorites]

The next time you ask why someone collapsed in a waiting room or died in a hallway, know it's partly because the ER has been providing primary care and post surgical care.

I think it would be more accurate to frame it as "because the primary care system is not providing either primary care or post-surgical care to large swathes of the population."

I'd be happy not to have the ER spending resources on promoting vaccinations when we are in the world where that's not necessary. Until then, here we are.
posted by praemunire at 11:40 PM on January 6, 2023 [7 favorites]

Exactly. Patients using the ED as primary care is a well-known issue. For some patients, ED care is their only care.

There's reasons for this -- mostly because people lack insurance, or if they are insured they don't have a primary care provider, or they know they can access care faster and with less friction through the ED.

One of the ways we can tip the balance in a big way toward primary care is by expanding care through Medicaid, ACA, and Medicare so people don't always head straight to the ED. We have 90 million Americans on Medicaid/CHIP right now, and another 35 million on the exchanges. That's great. We can do more.

When I started working in Medicaid managed care, it became very quickly apparent that through a certain lens, the purpose of the entire system is simply to get people to use primary care instead of heading straight to the ED. Why? ED care is gobs more expensive. It totally sinks the program's budget. Conservatives holler about the cost of Medicaid but they should be dancing in the streets for the money it saves in delivering healthcare. (And yet they're not. It's almost like they don't want people to have healthcare at all....)

I was in the hospital this week for A Thing and during prep I chatted with a nurse who'd been tending to covid patients in the ICU since the beginning of the pandemic until six months ago. Her eyes were deep. She said she did it for as long as she could. She was so kind, but still so tired. I'm glad she was about to switch departments instead of leaving healthcare entirely.

And it's hard. Burnout is so high. We ask so much. But from a hospital resource perspective, spending four minutes getting a patient informed and vaccinated means the hospital can avoid sending that same patient upstairs to spend three resource-intensive weeks in the ICU.
posted by mochapickle at 3:58 AM on January 7, 2023 [9 favorites]

Maybe as collective amnesia kicks in and media moves on, public health and health providers will be able to do the work they’ve been doing for decades without right-wing intervention. One bright possibility in the current weirdness.
posted by warriorqueen at 4:26 AM on January 7, 2023 [1 favorite]

I wonder how much adding urgent-care centers to this style of intervention would help?

Ironically, I was just at an urgent-care center this week and since I was there anyway, asked if I could get a bivalent booster--but no! They're not set up to store them. In this day and age! Associated with a major healthcare system, no less!

I can see we are all gung-ho about the ER doing yet another function of a basic primary care medical system.

I agree with the concern, but, if an ER giving someone a pamphlet or a little talk means that person gets a shot, then there's a lot less chance that person is going to come back and clog up the ER with a serious COVID infection.
posted by mittens at 6:11 AM on January 7, 2023 [8 favorites]

I think a lot of this too is about immediate availability for a population that can be so under stress that arranging to go get their COVID vaccine would otherwise immediately fall off their radar.

There was a year that I was going through some fairly significant mental health stuff brought on by stress, and I hadn’t gotten my flu shot yet. I was a ball of nerves and couldn’t organize my way out of a paper bag at the time. Zero time horizon, and just barely ticking the boxes of being functional. I was at an appointment with my primary care provider and she asked if I had gotten my flu shot, to which I said I usually do but I hadn’t yet. She pretty much walked me down the hall to get it. If she hadn’t, I would have left that appointment and never gotten around to going to a clinic or a pharmacy to get that done.

So I can see why in the moment of being cared for, whether the ER or otherwise, and being offered the shot right there would be immensely helpful.

*also, take this all with the caveat that I live where (despite some politicians best efforts to destroy it) there is universal healthcare.
posted by eekernohan at 6:29 AM on January 7, 2023 [6 favorites]

. Patients using the ED as primary care is a well-known issue

Years ago I saw an Ontario , Canada doctor speak about this.
There was a tendency to blame the patient for using the ED
He pointed out that a family doctor no longer accepts a chicken for payment.
They no longer deliver babies at the mothers home . They do not give stitches. Nor do they set broken arms or legs. Hell they don't even make housecalls.
This forces the patient to the ED.

There has been improvement since I saw that interview.
There are urgent care centres which accept walkins. They can perform day surgeries.
This takes pressure off the ED.
The increased use of walkin clinics here , though not as good as having a family doctor, helps.
posted by yyz at 6:46 AM on January 7, 2023 [3 favorites]

I’ve had a sore throat for the last 10 days. I’m breathing funny at night, hoping my throat isn’t closing up. I have good private health insurance through my employer. I have a primary care doc. I have an appointment on Monday with my primary care doc for a physical that I made 3 months ago. I’m waiting it out till Monday and will bring up the sore throat then. I don’t have many other options.

- PCP doesn’t work Fri, Sat, Sun
- If I’d called last week, unlikely I’d have been able to get an appointment right away
- There is an urgent care near me staffed by a nurse practitioner. When I went there for an emergency, they missed the diagnosis and I ended up in the emergency room anyway.
- Try to avoid ER at all costs. I waited in severe pain there for 8 hours before being seen.

We need more doctors going into family and internal medicine. The current trend of trying to fill the gap with nurse practitioners is insufficient, IMO. Why would anyone go into family med? Crazy high workloads for less pay than you get in other specialties. They seriously need way better pay.
posted by jenh526 at 7:13 AM on January 7, 2023 [3 favorites]

And lower debt loads coming out of med school and residency training.
posted by eviemath at 8:03 AM on January 7, 2023 [2 favorites]

I've lived in the United States in Chicago in an area with lots of medical infrastructure in my immediate area for a decade now with good health insurance coverage. I have never seen the same general practitioner doctor twice. Every doctor I have had has either moved, changed clinics, decided to become a specialist or some other thing. I've thought about trying to shop for a doctor in their 40s so they would be stable in their situation but really I've just pretty much given up on the idea that I could ever have continuity of care here. It simply isn't available to me and again that's with good health insurance. I get my vaccinations from CVS or Walgreens and when I had covid I went to a walk-in clinic for paxlovid so I am just one step removed from using an ER for primary care.

I can only imagine how much more difficult it is for people with worse situations in worse off neighborhoods.
posted by srboisvert at 9:22 AM on January 7, 2023 [4 favorites]

One of the ways we can tip the balance in a big way toward primary care is by expanding care through Medicaid, ACA, and Medicare so people don't always head straight to the ED.

Do you disagree with the rct on this? Medicaid expansion increased ED use, because when you make something cheaper people use more of it. With patient costs of basically zero, the pcp has to cover after hours, be available when convenient, be able to dispense, etc. to make it the better proposition.
posted by a robot made out of meat at 6:25 PM on January 7, 2023