It is important to understand the various ways COVID-19 may be impacting overall vaccination compliance. Throughout the COVID-19 pandemic, there have been notable drops in preventive care visits. Factors such as access, cost, and fear of COVID-19 exposure may have contributed to this noted decline.
Access to care has been limited in various ways such as reduced public transit capacities, medical office closures, and new childcare needs requiring adults to stay at home. Loss of employment and loss of insurance are some cost prohibiting reasons why care has been delayed. Fear of exposure to or contraction of COVID-19 has also been a factor leading people to delay care or perhaps choose alternative means of receiving care, such as through telemedicine.
A Harvard study analyzed changes in visit volumes from February through May 2020 based on data from Phreesia, a healthcare technology company. This study showed a 60% decline in ambulatory visits until early April, after which there was rebound noted; but the number of visits was still about a third lower than prior to the pandemic.¹ Another study from the Journal of General Internal Medicine examined the impact of COVID on preventive care and screening for cholesterol disease and diabetes in two large health institutions over a similar time period. This revealed an 81-90% drop in testing rates and a 52-60% drop in new medication therapy from February through March, with some rebound in early April.² The CDC’s May 8, 2020 Morbidity and Mortality Weekly Report, entitled Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration, showed a substantial reduction in orders for and administration of non-influenza childhood vaccines in March and April.
While it is not possible to predict how the ongoing COVID-19 pandemic will continue to unfold, it is important to be proactive in your measures to encourage preventive care maintenance including vaccinations in both the adult and pediatric populations. Creating a safe environment to encourage vaccination compliance is vital.
In anticipation of the unique challenges associated with the 2020-2021 Flu Season, the CDC has developed Making a Strong Flu Vaccine Recommendation. To aid in promoting flu vaccination, the CDC has also created the HCP Fight Flu Toolkit for medical practices, including age-specific recommendations, patient education materials, an appointment reminder template, and sample social media content.
Depending on your practice, additional strategies may include:
- Following CDC guidance to prevent the spread of COVID-19 in healthcare settings
- Using your reminder/recall system to identify patients that are due for vaccinations and contacting them to encourage scheduling a time to receive any outstanding vaccines and overdue or preventive care
- Developing patient education resources to address common concerns and encourage vaccination
- Using your practice website and patient portal to promote flu vaccination and preventive services
- Continuing pandemic infection control and screening measures
- Designating times for well patient vaccination visits in which no patients with upper respiratory symptoms will be present in the building
- Designating rooms for well patient vaccinations in which no other visits take place
- Taking time to educate and offer vaccinations during scheduled follow-up visits
- Offering vaccination to the parent or guardian accompanying a minor patient
- Offering alternate vaccination clinic locations, such as in outdoor tents or via drive-through
If alternate vaccination clinic locations are an option for your practice, the Guidance for Planning Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations, created by the CDC and the National Adult and Influenza Immunization Summit (NAIIS), provides best practices for holding vaccination clinics in non-traditional settings. They outline useful considerations during the initial planning stages as well as provide guidance for pre-clinic, during clinic, and post-clinic activities. They also provide a vaccine safety checklist, which outlines CDC guidelines and best practices for patient and vaccine safety. There is an option to pledge to adhere to these checklist guidelines and best practices to be recognized by NAIIS. To further aid in the process of holding alternate vaccination clinic locations, the CDC provides a vaccination supply checklist.
Be sure to inform your medical malpractice insurance carrier, your landlord and or property liability insurance carrier if you plan to offer vaccinations at an alternate clinic location or if you are a pediatrician, to the parent or guardian accompanying minor patients. NORCAL Group policyholders should contact their agent or call NORCAL Group at 844.466.7225.
Additional Resources
- CDC: Frequently Asked Influenza (Flu) Questions: 2020-2021 Season
- CDC: Vaccination Guidance During a Pandemic
- CDC: Interim Guidance for Routine and Influenza Immunization Services During the COVID-19 Pandemic
- CDC: Resources for Hosting a Vaccination Clinic
- NAIIS: FAQs about the Best Practices for Vaccination Clinics
- CDC: Immunization Schedule Changes and Guidance During the COVID-19 Pandemic, including vaccine catch-up guidance for pediatric patients
- American Academy of Pediatrics: Office Strategies for Improving Immunization Rates
- American Academy of Pediatrics: Immunizing Parents in the Pediatric Office Setting
- COVID-19 Prevention Network: COVID-19 Vaccination Clinical Studies
References
- Ateev Mehrotra et al., “The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges.” The Commonwealth Fund website. https://doi.org/10.26099/ds9e-jm36. Updated May 19, 2020. Accessed November 16, 2020.
- Wright, A., Salazar, A., Mirica, M., Volk, L. A., & Schiff, G. D. The Invisible Epidemic: Neglected Chronic Disease Management During COVID-19. Journal of general internal medicine. 2020; 35(9): 2816–2817. https://doi.org/10.1007/s11606-020-06025-4. Accessed November 16, 2020.
