COVID-19 Telemedicine and Vaccination at an Urban Safety Net HIV Medicine Clinic

Role of new vaccinators/pharmacists in life-course vaccination

BACKGROUND

Vaccines against diseases such as herpes zoster, pneumococcus and influenza are broadly recommended for older adults, but uptake is frequently low.

VACCINATION BOTTLENECK

Part of the reason may be that access to adult vaccination can be problematic, particularly for minorities and other under-served populations. Potential barriers include complex procedures, limited resources in healthcare systems and lack of structured infrastructure.

STRESS-TESTING EXPENDED VACCINATION

The Covid-19 pandemic necessitated rapid expansion of the infrastructure to deliver adult vaccination, and triggered the use of facilities including pharmacies, schools, faith-based organizations, community organizations, shops and hair salons, drive-through centres and mobile vaccination units.

IMPROVED ADULT VACCINATION SYSTEM

Although many such initiatives were temporary, they demonstrated the principle of effective expansion of adult vaccination and education to a range of new providers and settings. Of these, pharmacist involvement in immunization in particular has consistently been shown to be associated with increased immunization rates.

INTEGRATION OF NEW VACCINATORS

This review discusses results from attempts to expand and simplify the adult vaccination process, potentially allowing vaccination to be initiated by the recipient and completed in a single visit. These studies suggest that expanding adult vaccination access to new providers and/or new settings will require development of an integrated plan for preventive healthcare, covering areas such as setting target coverage rates, financial support, and development of immunization information systems accessible to all vaccination providers to maintain accurate immunization records and support interventions such as reminders.

Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review

AIM

To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care.

DESIGN

This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews.

DATA SOURCE/REVIEW METHODS

Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models.

RESULTS

One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy.

CONCLUSION

Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective.

IMPACT

Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally.

REPORTING METHOD

This review is reported against the PRISMA-ScR criteria.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

PROTOCOL REGISTRATION

The study protocol is published in BJGP Open (Moulton et al., 2022).

Telemedicine Implementation for Safety Net Populations: A Systematic Review

Background: Telemedicine systems were rapidly implemented in response to COVID-19. However, little is known about their effectiveness, acceptability, and sustainability for safety net populations. This study systematically reviewed primary care telemedicine implementation and effectiveness in safety net settings. Methods: We searched PubMed for peer-reviewed articles on telemedicine implementation from 2013 to 2021. The search was done between June and December 2021. Included articles focused on health care organizations that primarily serve low-income and/or rural populations in the United States. We screened 244 articles from an initial search of 343 articles and extracted and analyzed data from N = 45 articles. Results: Nine (20%) of 45 articles were randomized controlled trials. N = 22 reported findings for at least one marginalized group (i.e., racial/ethnic minority, 65 years+, limited English proficiency). Only n = 19 (42%) included African American/Black patients in demographics descriptions, n = 14 (31%) LatinX/Hispanic patients, n = 4 (9%) Asian patients, n = 4 (9%) patients aged 65+ years, and n = 4 (9%) patients with limited English proficiency. Results show telemedicine can provide high-quality primary care that is more accessible and affordable. Fifteen studies assessed barriers and facilitators to telemedicine implementation. Common barriers were billing/administrative workflow disruption (n = 9, 20%), broadband access/quality (n = 5, 11%), and patient preference for in-person care (n = 4, 9%). Facilitators included efficiency gains (n = 6, 13%), patient acceptance (n = 3, 7%), and enhanced access (n = 3, 7%). Conclusions: Telemedicine is an acceptable care modality to deliver primary care in safety net settings. Future studies should compare telemedicine and in-person care quality and test strategies to improve telemedicine implementation in safety net settings.