Access to vaccines, education from providers helped overcome hesitancy among our patients
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One of the challenges health care providers face in administering COVID-19 vaccines is vaccine hesitancy, especially among disadvantaged populations.
The HHS reports that a lower proportion of the Black and Hispanic populations have received a COVID-19 vaccination compared with the “non-Hispanic white population.” This is a troubling trend, particularly considering that end-stage kidney disease disproportionately affects communities of color. Of those on dialysis, 34% are Black patients and 19% are Hispanic patients.
Equitable distribution
By the end of April, more than 70% of DaVita patients nationwide had received at least one vaccine dose. To achieve this rate of COVID-19 vaccination among our diverse patient population, DaVita launched an equitable distribution strategy anchored in patient experience and convenience. The strategy included providing direct access to vaccines at every DaVita dialysis center and deploying comprehensive, multimedia educational resources.
DaVita and other dialysis providers worked closely with both the Trump and Biden administrations, the CDC and state governments to help ensure patients on dialysis had direct, convenient access to COVID-19 vaccines. As a result, during the first 6 months of this year, the kidney care community administered hundreds of thousands of COVID-19 vaccines directly to patients with ESKD in dialysis centers across the United States.
As a kidney care provider to more than 110,000 patients of color, ensuring equitable access to the vaccine has been a primary focus for DaVita, especially in rural areas and underserved communities. Through DaVita’s vaccine equity effort, we have significantly reduced the gap in vaccination rates between this patient group and white patients. However, eliminating the vaccine hesitancy gap altogether remains our target.
Vaccine hesitancy
To put this in perspective, high hesitancy rates led to a greater than 40% discrepancy between white and Asian American patient vaccination rates compared with those of Black and Hispanic patients early in the vaccine rollout. This gap is completely closed for our Hispanic patients and is down to 9% for Black patients compared with white patients.
According to the CDC, confidence in the vaccine administrator improves overall vaccine confidence. We largely attribute the high COVID-19 vaccination rate among DaVita patients to direct and convenient access to the vaccine at trusted sites of care. DaVita patients received comprehensive education about COVID-19 and the vaccine from trusted caregivers. In most cases, dialogue occurred within an established patient-provider relationship. We believe the existing rapport with each patient helped reduce barriers, making it possible to discuss common causes of hesitancy. Direct in-center education was combined with telephonic follow-up outreach and access to multimedia educational materials.
Additionally, we noticed some hesitant patients became more receptive to vaccination as they witnessed and spoke to other patients receiving the vaccine.
Giving patients access to the vaccine in their familiar site of care eliminated the burden of navigating appointments and the risk of traveling to third-party vaccination sites. Dialysis centers are well prepared to administer COVID-19 vaccines because centers routinely provide influenza, pneumonia and hepatitis vaccines. Patients also were able to receive the vaccine during their dialysis appointments, saving time and ensuring post-vaccination monitoring.
Throughout the COVID-19 pandemic, DaVita has cared for patients who are at high risk for complications related to COVID-19 due to multiple chronic comorbidities. The successful level of vaccination for patients with ESKD against COVID-19 demonstrates the unique role dialysis centers can play in addressing inequities in health care. As we begin to arrive at a so-called “new normal,” our pursuit of health equity among patients with kidney disease will continue.
References:
https://aspe.hhs.gov/system/files/pdf/265511/vaccination-disparities-brief.pdf. Accessed July 8, 2021.
www.whitehouse.gov/briefing-room/statements-releases/2021/03/25/fact-sheet-biden-administration-announces-historic-10-billion-investment-to-expand-access-to-covid-19-vaccines-and-build-vaccine-confidence-in-hardest-hit-and-highest-risk-communities/. Accessed July 8, 2021.
Jeffrey Giullian, MD, MBA, FASN, is the chief medical officer for DaVita Kidney Care and a member of the Editorial Advisory Board for Nephrology News & Issues. He can be reached at jeffrey.giullian@davita.com.
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