COVID-19 vaccine messaging in EDs boosts acceptance

Educational COVID-19 vaccine messaging in EDs increased vaccination acceptance and uptake among patients who were exposed to the intervention compared with a control group, a recent study found.

About 23% of the United States population is reluctant to receive a COVID-19 vaccine, according to Robert M. Rodriguez, MD, a professor in the department of emergency medicine at the University of California, San Francisco, and colleagues. Prior studies, they added, have found that EDs may “serve as key public health intervention sites,” particularly for patients who lack primary health care.

“We previously demonstrated that patients whose primary health care access occurs in EDs had greater COVID-19 vaccine hesitancy and other health care access barriers to COVID-19 vaccination than those with primary care,” the researchers wrote in JAMA Internal Medicine.

Using data obtained from ED patient interviews on vaccine hesitancy, Rodriguez and colleagues designed the Promotion of COVID-19 Va(X)ccination in the Emergency Department, or PROCOVAXED, messaging platform, which consisted of a 4-minute video, informational flyer and script for face-to-face ED clinician messaging.

Across four EDs, participants were randomly assigned into a control group (n = 275) or the intervention group (n = 221), with the latter receiving resources that were individualized based on the patients’ race and ethnicity. Of the participants, the median age was 39 years; 41.3% were women; 62% were Black, Hispanic or Native American; and 44% lacked a primary care physician.

Overall, Rodriguez and colleagues found that 25.8% of participants in the intervention group said they would accept the COVID-19 vaccine compared with 12% in the control group (adjusted difference, 11.9 percentage points; 95% CI, 4.5-19.3).

More intervention group participants also received a COVID-19 vaccination within 30 days of their ED visit compared with control group participants (20% vs. 8.7%; adjusted difference, 7.9 percentage points; 95% CI, 1.7-14.1).

Medically underserved groups were greatly impacted by the intervention, according to the researchers. In a sub-analysis of patients who did not have a PCP, vaccine acceptance (37.6% vs. 13.1%) and uptake (30.7% vs. 9.4%) were significantly higher in the intervention group compared with the control group. Similar differences were observed among Latinx patients for vaccine acceptance (44.2% vs. 10.4%) and uptake (42.3% vs. 8.3%).

“Notably, the finding of high intervention effect size in Latinx participants supports another underlying principle of our work — that diverse populations may be more receptive to messages when they are delivered by clinicians who look and speak like them,” the researchers wrote.

Rodriguez and colleagues said their research lays groundwork for the ED delivery of other public health messaging, “such as for hypertension and diabetes, to vulnerable populations who lack access to traditional clinic-based primary care.”

The researchers concluded that with the high number of ED visits across the country and ease of scalability, “if implemented nationally in EDs, these messaging platforms could lead to greater COVID-19 vaccine delivery to underserved populations whose primary health care access occurs in EDs.”

They also recommended that future ED interventions should consider vaccinating patients immediately following messaging instead of waiting or directing them elsewhere.

“Many participants who said that they would accept the vaccine in the ED did not get it there, indicating a need for optimization of ED vaccine supply and delivery workflow protocols,” they wrote.