Q&A: Strategy improves flu vaccination rates among underserved populations

Staff members at the Ohio State University Wexner Medical Center said they found a way to improve influenza vaccine uptake among underrepresented populations.

Last influenza season, 53% of white individuals received an influenza vaccine compared with just 38% of Hispanic individuals and 41% of Black individuals, according to a press release.

To reduce these disparities, health care workers at Ohio State University Wexner Medical Center called patients in underserved neighborhoods in Columbus, Ohio, to encourage them to receive the influenza vaccine and address their concerns. Nurses offered to administer the influenza vaccine in the ED or another setting “in which the patient feels comfortable receiving care from a provider they trust, including primary care and specialty clinics,” the press release said.

The initiative led to an influenza vaccination rate in underrepresented populations that exceeded the health system’s vaccination rate in this population last season, according to the press release. The Ohio State ED administered 10 times the number of influenza vaccines to non-white patients by March 2021 than the entire 2019-2020 season, the release said.

Although it remains unclear whether influenza will be widespread this season, “relaxed COVID-19 mitigation measures may result in an increase in flu activity during the upcoming 2021 to 2022 flu season,” according to the CDC.

Healio Primary Care spoke with Aaron Clark, DO, a family medicine physician at Ohio State and medical director of the Ohio State Health Accountable Care Organization, about the influenza vaccine initiative, how it could be tailored to increase COVID-19 vaccine uptake and more.

Healio Primary Care: Please describe the influenza vaccine initiative and how it was executed.

Clark: We had general strategies around enterprise level support (clinical, operational, technical). We leveraged existing The Ohio State University Wexner Medical Center patient access points (inpatient, ED, ambulatory, pharmacy, etc.) to administer immunizations. We developed internal and external stakeholder and community-oriented communications, which were culturally sensitive and addressed specific concerns from the non-white community specifically. We created a flu shot tracker dashboard to monitor success. We did strategic outreach with special focus to high risk/vulnerable patients in three key ZIP codes with higher percentages of non-white populations as well as those non-white patients who were hospitalized for influenza the year prior.

Healio Primary Care: What were the costs associated with this initiative?

Clark: Most likely, staff time to build the structure was the biggest cost. We used existing internal resources to direct a small work group to drive this project.

Healio Primary Care: Do you think the initiative will continue to be successful?

Clark: We are very hopeful that this will be an ongoing successful campaign well into the future. It was not designed to be a “one and done” approach, but rather a system-based response to health disparities.

Healio Primary Care: Could a similar initiative be used to increase uptake of the COVID‐19 vaccine? If so, how would you tailor the initiative?

Clark: The COVID-19 vaccine is a bit trickier with the handling of the vaccine itself (cold storage needs, etc.), so it’s not quite as easy to leverage the exact same strategies for it as were used for influenza.

However, we did learn to engage the community for better understanding of what kinds of barriers to immunization they experienced as well as learning what concerns and hesitancy might exist around immunizations. We were then able to address those concerns in a nonjudgmental way using trusted members of the medical staff and community to help in that messaging. That same tactic is the cornerstone of any successful health equity project.

Healio Primary Care: How can physicians encourage vaccinations without offending or belittling patients?

Clark: Be nonjudgmental. Ask about concerns. Be open and transparent in responses.

Respect individual decisions even if they might not align with official recommendations. Repeatedly offer the immunization over time. Build trust and understanding.

Healio Primary Care: What are some other ways Ohio State University Wexner Medical Center is addressing health care inequities?

Clark: We are also launching a similar effort designed to address the disparity in rates of colorectal cancer screening between our Black and non-Black patient populations.

References:

CDC. 2020-2021 flu season summary. https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm. Accessed Sept. 28, 2021.

CDC. Frequently asked influenza (flu) questions: 2021-2022 season. https://www.cdc.gov/flu/season/faq-flu-season-2021-2022.htm. Accessed Sept. 28, 2021.

Flu shot initiative aims to address racial inequities in health care. http://osuwmc.multimedia-newsroom.com/index.php/2021/08/30/flu-shot-initiative-aims-to-address-racial-inequities-in-healthcare/. Published Aug. 30, 2021. Accessed Sept. 28, 2021.