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De Guzman C, Thomas CA, Wiwanto L, Hu D, Henriquez-Rivera J, Gage L, Perreault JC, Harris E, Rastas C, McCormick D, Gaffney A. Health Care Access and COVID-19 Vaccination in the United States: A Cross-Sectional Analysis. Med Care 2024; 62:380-387. [PMID: 38728678 DOI: 10.1097/mlr.0000000000002005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Although federal legislation made COVID-19 vaccines free, inequities in access to medical care may affect vaccine uptake. OBJECTIVE To assess whether health care access was associated with uptake and timeliness of COVID-19 vaccination in the United States. DESIGN A cross-sectional study. SETTING 2021 National Health Interview Survey (Q2-Q4). SUBJECTS In all, 21,532 adults aged≥18 were included in the study. MEASURES Exposures included 4 metrics of health care access: health insurance, having an established place for medical care, having a physician visit within the past year, and medical care affordability. Outcomes included receipt of 1 or more COVID-19 vaccines and receipt of a first vaccine within 6 months of vaccine availability. We examined the association between each health care access metric and outcome using logistic regression, unadjusted and adjusted for demographic, geographic, and socioeconomic covariates. RESULTS In unadjusted analyses, each metric of health care access was associated with the uptake of COVID-19 vaccination and (among those vaccinated) early vaccination. In adjusted analyses, having health coverage (adjusted odds ratio [AOR] 1.60; 95% CI: 1.39, 1.84), a usual place of care (AOR 1.58; 95% CI: 1.42, 1.75), and a doctor visit within the past year (AOR 1.45, 95% CI: 1.31, 1.62) remained associated with higher rates of COVID-19 vaccination. Only having a usual place of care was associated with early vaccine uptake in adjusted analyses. LIMITATIONS Receipt of COVID-19 vaccination was self-reported. CONCLUSIONS Several metrics of health care access are associated with the uptake of COVID-19 vaccines. Policies that achieve universal coverage, and facilitate long-term relationships with trusted providers, may be an important component of pandemic responses.
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Affiliation(s)
- Charles De Guzman
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Chloe A Thomas
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Lynn Wiwanto
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Dier Hu
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jose Henriquez-Rivera
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Lily Gage
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jaclyn C Perreault
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Emily Harris
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Charlotte Rastas
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Adam Gaffney
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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2
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Spector S, Shah S, ul Rasool MH, Hilt E, Goldstein H, Meade J, Korn E, Lipetskaia L. Attitudes toward COVID-19 vaccination among urogynecology patients. Heliyon 2024; 10:e30092. [PMID: 38778988 PMCID: PMC11108857 DOI: 10.1016/j.heliyon.2024.e30092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 04/01/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Objective Urogynecology patients skew older and often require intimate exams to treat non-life-threatening conditions, thus making care particularly susceptible to the effects of COVID-19. We aim to understand COVID-19 vaccination attitudes amongst urogynecology patients during the pandemic, which has adversely affected healthcare delivery, to identify measures that can be undertaken to improve care going forward. Study design Cross-sectional surveys of urogynecology patients were conducted in three different states (Delaware, New Jersey, and Pennsylvania) between March and August 2021. Demographics, vaccination status, and COVID-19 attitudes were analyzed. Chi-square tests investigated group differences between vaccine-hesitant and unhesitant subjects. Results Out of 158 surveys, eighty-three percent of respondents were vaccinated or planning to get vaccinated. Older age and regular flu vaccination predicted COVID-19 vaccination. Ninety-three percent of subjects were comfortable attending in-person visits. However, vaccine-hesitant individuals were less comfortable attending in-person and were significantly less likely to be comforted by clinic interventions, such as masking. Hesitant and unhesitant groups trusted doctors or medical professionals most for their source of COVID-19 information. Conclusions Urogynecology patients mirror the general older population's COVID-19 vaccination attitudes, with distinct differences between hesitant and unhesitant groups. Vaccine-hesitant subjects appear less comfortable coming to in-person visits and less comforted by possible interventions, posing a difficult obstacle for clinics to overcome. High levels of patient trust suggest healthcare providers can play a crucial role in encouraging COVID-19 vaccination and combating misinformation.
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Affiliation(s)
- Sean Spector
- Department of Obstetrics and Gynecology, Cooper University Healthcare, Camden, NJ, USA
| | - Shanaya Shah
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Elizabeth Hilt
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Howard Goldstein
- Center for Urogynecology and Pelvic Surgery, Christiana Care Health System, Newark, DE, USA
| | - Jason Meade
- UroGynecology Specialty Center, Fresno, CA, USA
| | | | - Lioudmila Lipetskaia
- Department of Obstetrics and Gynecology, Cooper University Healthcare, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
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Ashcroft R, Donnelly C, Lam S, Sheffield P, Hamilton B, Kemp C, Adamson K, Brown JB. A qualitative examination of primary care team's participation in the distribution of the COVID-19 vaccination. BMC PRIMARY CARE 2024; 25:85. [PMID: 38486138 PMCID: PMC10938813 DOI: 10.1186/s12875-024-02327-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Primary health care (PHC) has historically led and implemented successful immunization programs, driven by strong relationships with patients and communities. During the COVID-19 pandemic, Canada began its vaccination strategy with mass immunizations that later included local efforts with PHC providers. This study seeks to understand how PHC contributed to the different phases of the COVID-19 vaccination rollouts in Ontario, Canada's most populous province. METHODS We conducted a descriptive qualitative study with focus groups consisting of PHC providers, administrators, and staff in Ontario. Eight focus groups were held with 39 participants representing geographic diversity across the six Ontario Health regions. Participants reflected a diverse range of clinical, administrative, and leadership roles. Each focus group was audio-recorded and transcribed with transcriptions analyzed using thematic analysis. RESULTS With respect to understanding PHC teams' participation in the different phases of the COVID-19 vaccination rollouts, we identified five themes: (i) supporting long-term care, (ii) providing leadership in mass vaccinations, (iii) integrating vaccinations in PHC practice sites, (iv) reaching those in need through outreach activities; and (v) PHC's contributions being under-recognized. CONCLUSIONS PHC was instrumental in supporting COVID-19 vaccinations in Ontario, Canada across all phases of the rollout. The flexibility and adaptability of PHC allowed teams to participate in both large-scale and small-scale vaccination efforts.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | | | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Bryn Hamilton
- Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Connor Kemp
- Frontenac, Lennox, and Addington Ontario Health Team, Kingston, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Lava JB, Claro VD, Quiñon MS, Labis R, Marcelo W, Lucero MA, Mendoza O, Stan L. Integrating COVID-19 Vaccination in Primary Care Service Delivery: Insights From Implementation Research in the Philippines. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300202. [PMID: 38378272 PMCID: PMC10948126 DOI: 10.9745/ghsp-d-23-00202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/19/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND In 2019, the Philippines enacted a universal health coverage law that aimed to establish an integrated health system centered around robust primary care as a core strategy of its health system reform agenda. Although the COVID-19 pandemic disrupted initial progress in the reform process, it also presented an opportunity to pilot interventions to demonstrate integration in various ways. METHODS We conducted a participatory implementation research study to integrate selected public health interventions into the implementation of the primary care benefit package funded by public health insurance. The study was conducted from October 2022 to April 2023 in the Province of Iloilo, Philippines. Entry points within the primary care service delivery process were identified, and interventions related to COVID-19 vaccination and family planning were implemented and monitored. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to organize the results and present the analysis. RESULTS The intervention showed substantial improvement across the 5 dimensions of the RE-AIM framework, including enhanced access to health care services, as indicated by improvements in primary care patient registration, family planning services, and COVID-19 vaccination processes, as well as an increase in registrations and first patient encounters. These improvements corresponded to sustained primary care facility participation throughout the study period. Additionally, emergent factors that either impeded or facilitated the integration process were identified, providing insights for effectively integrating COVID-19 vaccination within the primary care health system. CONCLUSION Our study provides evidence of the feasibility of integrating public health interventions into primary care settings. It highlights the potential of using existing primary care service delivery and financing mechanisms as entry points for integration. However, further iteration of the model is required to identify specific conditions for success that can be applied in other contexts and settings.
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Affiliation(s)
| | | | | | - Rodney Labis
- Provincial Health Office, Province of Iloilo, Iloilo City, Philippines
| | - Wendel Marcelo
- Provincial Health Office, Province of Iloilo, Iloilo City, Philippines
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Sugiyama K, Oshio T, Kuwahara S, Kimura H. Association between having a primary care physician and health behavioral intention in Japan: results from a nationwide survey. BMC PRIMARY CARE 2023; 24:280. [PMID: 38114896 PMCID: PMC10729517 DOI: 10.1186/s12875-023-02238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Introducing a primary care physician (Kakaritsuke-I: KI) system to improve the efficiency of the health care system has been controversial in Japan. This study aimed to determine the relevance of KI to an individual's health behavioral intentions. METHODS We used data from a nationwide, population-based internet survey (N = 5,234) to conduct a cross-sectional regression analysis. Additionally, we used a propensity score matching method to mitigate the potential endogenous biases inherent in the decision to have a KI. RESULTS KI was positively associated with various behavioral intentions. For example, the probabilities of intending to eat a well-balanced diet and engaging in moderate exercise were 12.8 (95% confidence interval [CI]:9.5-16.1) percentage points and 7.2 (95% CI: 3.9-10.4) percentage points higher, respectively, among those with a KI than among those without a KI. A KI equally increased the likelihood of getting vaccinated against coronavirus (in November 2021) by 7.5 (95% CI: 5.2-9.8) percentage points. CONCLUSIONS Although further analysis is needed to examine the effect of KI on health, the results of this study suggest the potential benefits of policy measures to promote the KI system.
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Affiliation(s)
- Kemmyo Sugiyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of Community Health, Public Health Institute, Shiwa, Iwate, Japan
| | - Takashi Oshio
- Institute of Economic Research, Hitotsubashi University, Kunitachi, Tokyo, Japan.
| | - Susumu Kuwahara
- Institute of Economic Research, Hitotsubashi University, Kunitachi, Tokyo, Japan
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6
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Stevens CW, Neely SR, Scacco JM. Breakthrough infections and acceptance of COVID-19 vaccine boosters: A survey analysis. PEC INNOVATION 2023; 2:100167. [PMID: 37214503 PMCID: PMC10186844 DOI: 10.1016/j.pecinn.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/14/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023]
Abstract
Objective This Short Communication explores the effect of COVID-19 breakthrough infections (defined as a COVID-19 diagnosis after vaccination) on the willingness of previously vaccinated individuals to receive ongoing vaccine boosters. Specifically, we examine unique effects for three different breakthrough infection experiences, including the participant themselves, a close member of their family, and a friend/coworker. Methods A representative, web-based survey of 600 adults in the state of Florida was fielded in March/April of 2022. Among the respondents, 455 had been vaccinated against COVID-19. Their responses were analyzed for this study using both descriptive and inferential statistical methods. Results Individuals who have experienced a personal breakthrough infection are two times less likely to receive annual vaccine boosters, ceteris paribus. However, there is not a statistically significant relationship between vaccine acceptance and breakthrough infections among close family members or friends/coworkers. We also found a very strong relationship between vaccine decisions and confidence in public health guidance. Conclusion Our findings show that confidence in public health guidelines is the most compelling determinant of vaccine acceptance, but breakthrough infections also have a significant impact on individual decision making when it comes to ongoing vaccination. Going forward, public health messaging should directly account for this correlation in order to effectively maintain vaccination levels. Innovation The COVID-19 pandemic marked a turning point in the development and deployment of mRNA vaccines. This study contributes to innovation in health communication research by examining how breakthrough infections in these vaccinated individuals impacts ongoing booster shot acceptance. The findings of this study contribute to the nascent and ongoing development of baseline research in this area.
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Affiliation(s)
- Christina W Stevens
- University of South Florida, School of Public Affairs, United States of America
| | - Stephen R Neely
- University of South Florida, School of Public Affairs, United States of America
| | - Joshua M Scacco
- University of South Florida, Department of Communication, United States of America
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Sanftenberg L, Keppeler S, Heithorst N, Dreischulte T, Roos M, Sckopke P, Bühner M, Gensichen J. Psychological Determinants of Vaccination Readiness against COVID-19 and Seasonal Influenza of the Chronically Ill in Primary Care in Germany-A Cross-Sectional Survey. Vaccines (Basel) 2023; 11:1795. [PMID: 38140199 PMCID: PMC10747451 DOI: 10.3390/vaccines11121795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Vaccines against COVID-19 and influenza are highly recommended for the chronically ill. They often suffer from co-morbid mental health issues. This cross-sectional observational study analyzes the associations between depression (PHQ-9) and anxiety (OASIS) with vaccination readiness (5C) against COVID-19 and influenza in chronically ill adults in primary care in Germany. Sociodemographic data, social activity (LSNS), patient activation measure (PAM), and the doctor/patient relationship (PRA) are examined as well. Descriptive statistics and linear mixed-effects regression models are calculated. We compare data from n = 795 study participants. The symptoms of depression are negatively associated with confidence in COVID-19 vaccines (p = 0.010) and positively associated with constraints to get vaccinated against COVID-19 (p = 0.041). There are no significant associations between symptoms of depression and vaccination readiness against influenza. Self-reported symptoms of a generalized anxiety disorder seem not to be associated with vaccination readiness. To address confidence in COVID-19 vaccines among the chronically ill, targeted educational interventions should be elaborated to consider mental health issues like depression. As general practitioners play a key role in the development of a good doctor/patient relationship, they should be trained in patient-centered communication. Furthermore, a standardized implementation of digital vaccination management systems might improve immunization rates in primary care.
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Affiliation(s)
- Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.K.); (N.H.); (T.D.); (J.G.)
| | - Simon Keppeler
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.K.); (N.H.); (T.D.); (J.G.)
| | - Nadine Heithorst
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.K.); (N.H.); (T.D.); (J.G.)
| | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.K.); (N.H.); (T.D.); (J.G.)
| | - Marco Roos
- General Practice, Medical Faculty, University of Augsburg, 86356 Neusäß, Germany;
| | - Philipp Sckopke
- Department of Psychology, LMU Munich, 80802 Munich, Germany; (P.S.); (M.B.)
| | - Markus Bühner
- Department of Psychology, LMU Munich, 80802 Munich, Germany; (P.S.); (M.B.)
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.K.); (N.H.); (T.D.); (J.G.)
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Kalatzi P, Travlos AK, Geladas N, Iliadou M, Tzavara C, Chryssanthopoulos C, Mihopoulos A, Tziaferi S. Vaccination coverage of primary care providers against seasonal influenza, tetanus, pneumococcal pneumonia and herpes zoster: A cross-sectional study in Greece. AIMS Public Health 2023; 10:952-963. [PMID: 38187900 PMCID: PMC10764975 DOI: 10.3934/publichealth.2023061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Primary care providers' (PCPs) compliance to self-immunization is important for their protection and the protection of their colleagues and patients and has been associated with the coverage of the general public. In this study, we aim to investigate the vaccination coverage of PCPs. Methods A questionnaire-based cross-sectional survey was conducted among physicians, nurses and pharmacists employed in public or private primary care settings in Greece. Demographic and occupational characteristics as well as vaccination coverage data for influenza, tetanus, pneumococcal pneumonia and herpes zoster were collected. Statistical significance was set at 0.05. Results In total, 748 (61.7% response rate) PCPs participated. Vaccination rates were 66.4% (496/747) for influenza (2019/2020 flu season), 62.9% (469/746) for tetanus (10-year Td or Tdap booster dose), 70% (14/20) for pneumococcal pneumonia (≥ 1 dose of PPSV23 or PCV13) and 12.3% (10/81) for herpes zoster. Multiple logistic regression revealed that nurses had significantly lower probability of being vaccinated against influenza [odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.14-0.45] and pharmacists had significantly lower probability of being vaccinated against both influenza (OR = 0.44; 95% CI = 0.31-0.62) and influenza & tetanus (OR = 0.52; 95% CI = 0.37-0.73) compared to physicians. Older age (>40 years) was an independent risk factor for not receiving a tetanus vaccine (40-49 vs. 19-39; OR = 0.42; 95% CI = 0.28-0.63, over 50 years old vs. 19-39; OR = 0.54; 95% CI = 0.36-0.79). Conclusions The results revealed suboptimal vaccination rates among health providers who are in the frontline of adult immunization. Individualized and targeted measures to improve their vaccination coverage and indirectly the vaccination coverage of their patients, are therefore required.
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Affiliation(s)
- Panagiota Kalatzi
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Tripoli, Greece
| | - Antonios K. Travlos
- Department of Sports Organization and Management, University of Peloponnese, Sparti, Greece
| | - Nickos Geladas
- Department of Physical Education & Sport Science, National & Kapodistrian University of Athens, Athens, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Chara Tzavara
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Alexandros Mihopoulos
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Tripoli, Greece
| | - Styliani Tziaferi
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Tripoli, Greece
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Ledford CJW, Harrison Z, Stein TL, Vikram SV, Williamson LD, Whitebloom GC, Seehusen DA. Education, trust, and likelihood to vaccinate against COVID-19 among patients with diabetes in the American South. PATIENT EDUCATION AND COUNSELING 2023; 115:107905. [PMID: 37506524 DOI: 10.1016/j.pec.2023.107905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE The purpose of this study was to explain the relationship among education, likelihood to vaccinate for COVID-19, and trust in healthcare providers among patients living with diabetes in the American South. METHODS Explanatory iterative sequential mixed methods design combined retrospective chart review, self-report surveys, and qualitative interviews. RESULTS Analysis of covariance revealed that severity of diabetes was not linked to vaccine acceptance. Overall, patients reported higher likelihood to vaccinate if their healthcare providers strongly recommend the vaccine. People with "some college" education reported lowest likelihood to vaccinate, before and after their healthcare providers' strong recommendation. Integrated analysis revealed the complexity of patient-provider trust and vaccination decisions. CONCLUSIONS In the context of COVID vaccination, particularly as conspiracy theories entered the mainstream, measures of trust in the system may be a clearer indicator of vaccine decision making than trust in personal physician. PRACTICE IMPLICATIONS The nonlinear relationship between education and likelihood to vaccinate challenges providers to talk to patients about knowledge and understanding beyond a superficial, quantitative screening question about education. Health systems and public health officials need to find strategies to build trusting relationships for patients across systems, such as community health workers.
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Affiliation(s)
- Christy J W Ledford
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | - Zachary Harrison
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tao Li Stein
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Sandya V Vikram
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Grant C Whitebloom
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Dean A Seehusen
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Nuzhath T, Spiegelman A, Scobee J, Goidel K, Washburn D, Callaghan T. Primary care physicians' strategies for addressing COVID-19 vaccine hesitancy. Soc Sci Med 2023; 333:116150. [PMID: 37595423 DOI: 10.1016/j.socscimed.2023.116150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To explore the strategies that primary care physicians use to address patient COVID-19 vaccine hesitancy. METHOD We administered an online survey to 625 primary care physicians from May 14 to May 25, 2021, to assess the messages that primary care physicians use to encourage hesitant patients to get vaccinated against COVID-19.589 physicians from the total pool of 625 provided open-ended responses. We conducted thematic content analysis on the responses based on previous research and themes identified within the data. SETTING The survey was administered online using the survey research firm Dynata. RESULTS Eleven primary themes emerged from our analysis, which included, physicians addressing specific concerns about vaccine safety (including costs versus benefits), physicians helping patients understand what it means to remain unvaccinated, or whether physicians try to connect emotionally through the use of guilt, or personal experience, whether physicians use derisive language to communicate with unvaccinated patients. In addition, a small number of physicians indicated they would not attempt to persuade someone who is vaccine hesitant. CONCLUSIONS Our study shows that while some of the physicians used different strategies to address vaccine hesitancy, some of the physicians used harsh language or did not make any effort to reduce COVID-19 related vaccine hesitancy among their patients. Focused advocacy and training are needed to increase physician engagement in vaccine-related dialogues with their patients. Such efforts will ensure that critical opportunities for patient education and awareness-building are not missed and ensure high levels of vaccination uptake.
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Affiliation(s)
- Tasmiah Nuzhath
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health. Huntington Ave, Boston, MA, 02115, USA; Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University. 212 Adriance Lab Rd. 1266 TAMU, College Station, TX, USA.
| | | | - Julia Scobee
- Department of Health Law, Policy and Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, USA
| | - Kirby Goidel
- Department of Political Science, Texas A&M University, 2935, Research Pkwy, College Station, TX, USA
| | - David Washburn
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, USA
| | - Timothy Callaghan
- Department of Health Law, Policy and Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, USA
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11
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Peano A, Politano G, Gianino MM. Determinants of COVID-19 vaccination worldwide: WORLDCOV, a retrospective observational study. Front Public Health 2023; 11:1128612. [PMID: 37719735 PMCID: PMC10501313 DOI: 10.3389/fpubh.2023.1128612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/19/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction The COVID-19 pandemic has resulted in numerous deaths, great suffering, and significant changes in people's lives worldwide. The introduction of the vaccines was a light in the darkness, but after 18 months, a great disparity in vaccination coverage between countries has been observed. As disparities in vaccination coverage have become a global public health issue, this study aimed to analyze several variables to identify possible determinants of COVID-19 vaccination. Methods An ecological study was conducted using pooled secondary data sourced from institutional sites. A total of 205 countries and territories worldwide were included. A total of 16 variables from different fields were considered to establish possible determinants of COVID-19 vaccination: sociodemographic, cultural, infrastructural, economic and political variables, and health system performance indicators. The percentage of the population vaccinated with at least one dose and the total doses administered per 100 residents on 15 June 2022 were identified as indicators of vaccine coverage and outcomes. Raw and adjusted values for delivered vaccine doses in the multivariate GLM were determined using R. The tested hypothesis (i.e., variables as determinants of COVID-19 vaccination) was formulated before data collection. The study protocol was registered with the grant number NCT05471635. Results GDP per capita [odds = 1.401 (1.299-1.511) CI 95%], access to electricity [odds = 1.625 (1.559-1.694) CI 95%], political stability, absence of violence/terrorism [odds = 1.334 (1.284-1.387) CI 95%], and civil liberties [odds = 0.888 (0.863-0.914) CI 95%] were strong determinants of COVID-19 vaccination. Several other variables displayed a statistically significant association with outcomes, although the associations were stronger for total doses administered per 100 residents. There was a substantial overlap between raw outcomes and their adjusted counterparts. Discussion This pioneering study is the first to analyze the association between several different categories of indicators and COVID-19 vaccination coverage in a wide complex setting, identifying strong determinants of vaccination coverage. Political decision-makers should consider these findings when organizing mass vaccination campaigns in a pandemic context to reduce inequalities between nations and to achieve a common good from a public health perspective.
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Affiliation(s)
- Alberto Peano
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Polytechnic of Turin, Turin, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
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12
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Hao S, Rehkopf DH, Velasquez E, Vala A, Bazemore AW, Phillips RL. COVID-19 Vaccine Strategy Left Small Primary Care Practices On The Sidelines. Health Aff (Millwood) 2023; 42:1147-1151. [PMID: 37549323 DOI: 10.1377/hlthaff.2023.00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
We report on the experience of small primary care practices participating in a national clinical registry with COVID-19 vaccines and vaccination data. At the end of 2021, 11.2 percent of these practices' 3.9 million patients had records of COVID-19 vaccination; 43.1 percent of clinics had no record of patients' COVID-19 vaccinations, but 93.4 percent of clinics had provided or recorded other routine vaccinations.
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Affiliation(s)
- Shiying Hao
- Shiying Hao, Stanford University, Stanford, California
| | | | | | | | - Andrew W Bazemore
- Andrew W. Bazemore, American Board of Family Medicine, Lexington, Kentucky
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13
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Aggarwal M, Kokorelias KM, Glazier RH, Katz A, Shiers-Hanley JE, Upshur REG. What is the role of primary care in the COVID-19 vaccine roll-out and the barriers and facilitators to an equitable vaccine roll-out? A rapid scoping review of nine jurisdictions. BMJ Open 2023; 13:e065306. [PMID: 37076148 PMCID: PMC10123853 DOI: 10.1136/bmjopen-2022-065306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES This study aimed to: (1) examine the experience of nine global jurisdictions that engaged primary care providers (PCPs) to administer COVID-19 vaccines during the pandemic; (2) describe how vaccine hesitancy and principles of equity were incorporated in the COVID-19 vaccine roll-out strategies and (3) identify the barriers and facilitators to the vaccine roll-out. DESIGN Rapid scoping review. DATA SOURCES Searches took place in MEDLINE, CINAHL, Embase, the Cochrane Library, SCOPUS and PsycINFO, Google, and the websites of national health departments. Searches and analyses took place from May 2021 to July 2021. RESULTS Sixty-two documents met the inclusion criteria (35=grey literature; 56% and 27=peer reviewed; 44%). This review found that the vaccine distribution approach started at hospitals in almost all jurisdictions. In some jurisdictions, PCPs were engaged at the beginning, and the majority included PCPs over time. In many jurisdictions, equity was considered in the prioritisation policies for various marginalised communities. However, vaccine hesitancy was not explicitly considered in the design of vaccine distribution approaches. The barriers to the roll-out of vaccines included personal, organisational and contextual factors. The vaccine roll-out strategy was facilitated by establishing policies and processes for pandemic preparedness, well-established and coordinated information systems, primary care interventions, adequate supply of providers, education and training of providers, and effective communications strategy. CONCLUSIONS Empirical evidence is lacking on the impact of a primary care-led vaccine distribution approach on vaccine hesitancy, adoption and equity. Future vaccine distribution approaches need to be informed by further research evaluating vaccine distribution approaches and their impact on patient and population outcomes.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kristina Marie Kokorelias
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Richard H Glazier
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alan Katz
- Department of Community Health Sciences, Rady Faculty of Health Sciences University, Winnipeg, Manitoba, Canada
| | | | - Ross E G Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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Sahakyan S, Gharibyan N, Aslanyan L, Hayrumyan V, Harutyunyan A, Libaridian L, Grigoryan Z. Multi-Perspective Views and Hesitancy toward COVID-19 Vaccines: A Mixed Method Study. Vaccines (Basel) 2023; 11:vaccines11040801. [PMID: 37112713 PMCID: PMC10147024 DOI: 10.3390/vaccines11040801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
The worldwide uptake of COVID-19 vaccines was suboptimal throughout the pandemic; vaccine hesitancy played a principle role in low vaccine acceptance both globally and in Armenia. In order to understand the factors behind the slow vaccine uptake in Armenia, we aimed to explore the prevailing perceptions and experiences of healthcare providers and the general public related to COVID-19 vaccines. The study applied a convergent parallel mixed-methods study design (QUAL-quant) through in-depth interviews (IDI) and a telephone survey. We completed 34 IDIs with different physician and beneficiary groups and a telephone survey with 355 primary healthcare (PHC) providers. The IDIs found that physicians held variable views on the need for COVID-19 vaccination which, combined with mixed messaging in the media landscape, fueled the public’s vaccine hesitancy. The survey results were mostly consistent with the qualitative findings as 54% of physicians hypothesized that COVID-19 vaccines were rushed without appropriate testing and 42% were concerned about the safety of those vaccines. Strategies to improve vaccination rates must target the main drivers of hesitancy, such as physicians’ poor knowledge of specific vaccines and spiraling misconceptions about them. Meanwhile, timely educational campaigns with targeted messaging for the general public should address misinformation, promote vaccine acceptance, and empower their capacity to make decisions about their health.
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Affiliation(s)
- Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Natella Gharibyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Lusine Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Arusyak Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Lorky Libaridian
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA
| | - Zaruhi Grigoryan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
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15
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Sodhi S, Chamali R, Praveen D, Sharma M, Garcia Dieguez M, Mash R, Goodyear-Smith F, Ponka D. Protocol for a cross-sectional study on COVID-19 vaccination programmes in primary health care. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 36744460 PMCID: PMC9900242 DOI: 10.4102/phcfm.v15i1.3649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND An integrated primary health care approach, where primary care and public health efforts are coordinated, is a key feature of routine immunisation campaigns. AIM The aim of the study is to describe the approach used by a diverse group of international primary health care professionals in delivering their coronavirus disease 2019 (COVID-19) vaccination programmes, as well as their perspectives on public health and primary care integration while implementing national COVID-19 vaccination programmes in their own jurisdictions. SETTING This is a protocol for a study, which consists of a cross-sectional online survey disseminated among a convenience sample of international primary health care professional through member-based organisations and professional networks via email and online newsletters. METHODS Survey development followed an iterative validation process with a formative committee developing the survey instrument based on study objectives, existing literature and best practices and a summative committee verifying and validating content. RESULTS Main outcome measures are vaccination implementation approach (planning, coordination service deliver), level or type of primary care involvement and degree of primary care and public health integration at community level. CONCLUSION Integrated health systems can lead to a greater impact in the rollout of the COVID-19 vaccine and can ensure that we are better prepared for crises that threaten human health, not only limited to infectious pandemics but also the rising tide of chronic disease, natural and conflict-driven disasters and climate change.Contribution: This study will provide insight and key learnings for improving vaccination efforts for COVID-19 and possible future pandemics.
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Affiliation(s)
- Sumeet Sodhi
- Besrour Centre for Global Family Medicine, College of Family Physicians of Canada, Mississauga, Canada; and Toronto Western Hospital, University Health Network, Toronto, Canada; and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto.
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16
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Maeder M, Auderset D, Borel B, Masserey E, Schwarz J, Mueller Y. Trends in COVID-Related Activity in Sentinel Family Medicine Practices: An Observational Study. Int J Public Health 2023; 67:1605361. [PMID: 36726524 PMCID: PMC9884669 DOI: 10.3389/ijph.2022.1605361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives: During the COVID pandemic, data collected in family medicine were scarce. The COVID-FM project aimed to monitor trends of COVID-related activity in family medicine practices of the canton of Vaud, Switzerland, during the year 2021. Methods: Practitioners were invited to join an ad hoc sentinel surveillance system. Online data collection was based on daily activity reports and monthly questionnaires. Participants categorized daily counts of consultations and phone calls into predefined categories. Data were reported and discussed on a weekly basis with public health authorities. Results: On the target of 50 physicians, 37 general physicians from 32 practices finally constituted the COVID-FM sentinel network, contributing to 901 practice-weeks of surveillance in family medicine and 604 in paediatrics. In paediatrics, COVID-related activity corresponded mostly to COVID-19 diagnostic consultations (2911/25990 face-to-face consultations = 11.2%) while in family medicine, other COVID-related topics-such as questions on vaccination-predominated (4143/42221 = 9.8%). Conclusion: COVID-related consultations constituted an important part of primary care practices' activity in 2021. Monitoring COVID-related activity in primary care provided health authorities with valuable information to guide public health action.
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Affiliation(s)
- Muriel Maeder
- Department of Family Medicine, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Diane Auderset
- Department of Family Medicine, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | | | - Joëlle Schwarz
- Department of Family Medicine, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yolanda Mueller
- Department of Family Medicine, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland,*Correspondence: Yolanda Mueller,
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17
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Sirkin JT, Flanagan E, Tong ST, Coffman M, McNellis RJ, McPherson T, Bierman AS. Primary Care's Challenges and Responses in the Face of the COVID-19 Pandemic: Insights From AHRQ's Learning Community. Ann Fam Med 2023; 21:76-82. [PMID: 36690493 PMCID: PMC9870647 DOI: 10.1370/afm.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
The COVID-19 pandemic dramatically disrupted health care systems and delivery in the United States. Despite emotional, psychological, logistical, and financial stress, primary care clinicians responded to the challenges that COVID-19 presented and continued to provide essential health services to their communities. As the lead federal agency for primary care research, the Agency for Healthcare Research and Quality (AHRQ) identified a need to engage and support primary care in responding to COVID-19. AHRQ initiated a learning community from December 2020-November 2021 to connect professionals and organizations that support primary care practices and clinicians. The learning community provided a forum for participants to share learning and peer support, better understand the stressors and challenges confronting practices, ascertain needs, and identify promising solutions in response to the pandemic. We identified challenges, responses, and innovations that emerged through learning community engagement, information sharing, and dialog. We categorized these across 5 domains that reflect core areas integral to primary care delivery: patient-centeredness, clinician and practice, systems and infrastructure, and community and public health; health equity was crosscutting across all domains. The engagement of the community to identify real-time response and innovation in the context of a global pandemic has provided valuable insights to inform future research and policy, improve primary care delivery, and ensure that the community is better prepared to respond and contribute to ongoing and future health challenges.
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Affiliation(s)
| | | | | | - Megan Coffman
- NORC at the University of Chicago, Chicago, Illinois
| | - Robert J McNellis
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland
| | | | - Arlene S Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland
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18
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Al-Dahir S, Earls M, Gillard C, Singleton B, Hall E. Assessing the Impact of COVID-19 Phased Vaccine Eligibility on COVID-19 Vaccine Intent among African Americans in Southeastern Louisiana: A Community-Based, Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16737. [PMID: 36554617 PMCID: PMC9779262 DOI: 10.3390/ijerph192416737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
The purpose of this study was to explore the impact of eligibility for the coronavirus 2019 (COVID-19) vaccine at the time of the vaccine rollout as a predictor of vaccine intent within the African American community. METHODS Four hundred eighty-seven African American participants in southeastern Louisiana were surveyed from January-April of 2021, with follow-up surveys occurring in Fall 2021. Survey domains included demographics, vaccine hesitancy, discrimination in the healthcare setting, and knowledge and experiences with COVID-19. Descriptive statistics, Chi-square tests, and binary logistic regression were performed. RESULTS Participants eligible for the vaccine were 1.61 times as likely to express positive vaccine intent versus ineligible participants. Additional predictors of vaccine intent were age, insurance status and coverage, and female sex at birth. In the multivariable logistic analysis, eligible individuals were 2.07 times as likely to receive the vaccine versus ineligible individuals. CONCLUSIONS Vaccine eligibility for the COVID-19 vaccine was a significant predictor of intent to vaccinate in the African American community. Younger individuals were less likely to have a positive intent, correlating with the eligibility of ages 16+ occurring 5 months post-vaccine approval.
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19
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Neely SR, Scacco JM. Receptiveness of American adults to COVID-19 vaccine boosters: A survey analysis. PEC INNOVATION 2022; 1:100019. [PMID: 35360835 PMCID: PMC8791622 DOI: 10.1016/j.pecinn.2022.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 12/03/2022]
Abstract
Objective This Short Communication report summarizes results from a recent survey on the willingness of American adults to accept COVID-19 vaccine boosters. We seek to identify evolving hesitancies and objections to booster shots among those who previously accepted vaccination. Methods A representative, web-based survey of 600 adults in the State of Florida was fielded, and the results are analyzed using both descriptive and inferential statistical methods. Results The survey responses show that while booster shot hesitancy is relatively low among vaccinated Americans, nearly a third (30.4%) say that they are only somewhat likely or less to receive a vaccine booster shot. Statistical analysis shows that trust in public health guidance is the driving factor behind booster shot hesitancy, while significant differences also exist based on race and level of education. The most frequently cited objections to booster shots include concerns over the necessity of additional shots and adverse reactions to the initial vaccination. Conclusion Objections to booster shots highlight emerging communications challenges that health professional will need to consider and address as vaccine guidance continues to evolve. Innovation This study contributes to innovation in health communications by identifying emerging challenges and barriers in the ongoing effort to promote COVID-19 vaccination.
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Affiliation(s)
- Stephen R Neely
- University of South Florida, School of Public Affairs, 4202 E. Fowler Ave, SOC 107, Tampa, FL 33620, United States of America
| | - Joshua M Scacco
- University of South Florida, Department of Communication, 4202 E. Fowler Ave, CIS 1040, Tampa, FL 33620, United States of America
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20
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Jiang H, Zhao Q, Chen K, Yang J, Li Q. The main features of physician assistants/associates and insights for the development of similar professions in China. J Evid Based Med 2022; 15:398-407. [PMID: 36573381 DOI: 10.1111/jebm.12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022]
Abstract
The physician assistant/associate (PA) profession originated in the United States; PAs play an active role in alleviating the shortage of health and medical resources and improving the quality of medical care. This position has been introduced in and developed by many countries. Based on extensive literature research, this article summarizes the three main features of PAs, namely, that there is professional education for training PAs, the PA is an independent and exclusive professional type and PAs assist doctors in completing medical work. With reference to the innovative concept of the PA profession, this article summarized the existing "assistant" position in China that is similar to the PA position, compared it with the three features of PAs, revealed the shortcomings of the existing "assistant" position in China, provided a reference for the development of relevant careers in China, and provided solutions for solving the problems of medical and health resources in China.
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Affiliation(s)
- Huili Jiang
- School of Health Policy and Management, Peking Union Medical College, Beijing, P.R. China
| | - Qianqian Zhao
- School of Health Policy and Management, Peking Union Medical College, Beijing, P.R. China
| | - Keyu Chen
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Juntao Yang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Qing Li
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
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21
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Kiran T, Wang R, Handford C, Laraya N, Eissa A, Pariser P, Brown R, Pedersen C. Family physician practice patterns during COVID-19 and future intentions: Cross-sectional survey in Ontario, Canada. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:836-846. [PMID: 36376032 PMCID: PMC9833162 DOI: 10.46747/cfp.6811836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the extent to which family physicians closed their doors altogether or for in-person visits during the pandemic, their future practice intentions, and related factors. DESIGN Cross-sectional survey. SETTING Six geographic areas in Toronto, Ont, aligned with Ontario Health Team regions. PARTICIPANTS Family doctors practising office-based, comprehensive family medicine. MAIN OUTCOME MEASURES Practice operations in January 2021, use of virtual care, and future plans. RESULTS Of the 1016 (85.7%) individuals who responded to the survey, 99.7% (1001 of 1004) indicated their practices were open in January 2021, with 94.8% (928 of 979) seeing patients in person and 30.8% (264 of 856) providing in-person care to patients reporting COVID-19 symptoms. Respondents estimated spending 58.2% of clinical care time on telephone visits, 5.8% on video appointments, and 7.5% on e-mail or secure messaging. Among respondents, 17.5% (77 of 439) were planning to close their existing practices in the next 5 years. There were higher proportions of physicians who worked alone in clinics among those who did not see patients in person (27.6% no vs 12.4% yes, P<.05), among those who did not see symptomatic patients (15.6% no vs 6.5% yes, P<.001), and among those who planned to close their practices in the next 5 years (28.9% yes vs 13.9% no, P<.01). CONCLUSION Most family physicians in Toronto were open to in-person care in January 2021, but almost one-fifth were considering closing their practices in the next 5 years. Policy makers need to prepare for a growing family physician shortage and better understand factors that support recruitment and retention.
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Affiliation(s)
- Tara Kiran
- Vice-Chair of Quality and Innovation in the Department of Family and Community Medicine (DFCM) at the University of Toronto in Ontario, Associate Professor in the Faculty of Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto, Scientist in the MAP Centre for Urban Health Solutions at St Michael’s Hospital in Toronto and a staff physician in the DFCM at St Michael’s Hospital.,Correspondence Dr Tara Kiran; e-mail
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22
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Fischer A, Shapiro J, Nguyen T, Meckler G, Lam T, Mai U, Fenning R, De La Cruz JP, Haq C. Views from the trenches: California family physicians' challenges and resilience factors while providing patient care during the initial wave of COVID-19. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2022; 6:10296. [PMID: 37440773 PMCID: PMC10336883 DOI: 10.4081/qrmh.2022.10296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/11/2022] [Indexed: 07/15/2023] Open
Abstract
This study examined challenges and factors promoting resilience among 20 California family physicians (FPs) during the first six months of the COVID-19 pandemic. A subset of academic, community, and resident FPs who responded to an online survey also participated in a semi-structured interview that explored concerns, moral distress, burnout, resource needs, support systems, coping strategies, and motivation to continue caring for patients. Thematic analysis was used to identify common themes in participant interviews. Interviewees demonstrated adaptability, resilience, and grit (i.e., commitment to completing a valued goal in the face of setbacks and adversity) despite challenges disrupting patient care, fears for family and self, and frustration due to the politicization of the pandemic. Factors promoting well-being and perseverance included professional and personal support, strong coping skills, and focusing on the meaning derived from practicing medicine. A service orientation that permeates family medicine philosophy and values motivated practitioners to continue to provide patient care while dealing with overwhelming personal and structural challenges. FPs drew strength from their internal coping skills, core family medicine values, and external support, notwithstanding demoralizing effects of mixed messages and politicization of the pandemic. FPs demonstrated resilience and grit in the face of challenges created by the COVID-19 pandemic. Ensuring adequate resources to promote a physically and psychologically healthy workforce while increasing access to care for all patients is crucial to prepare for the next healthcare crisis.
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Affiliation(s)
| | | | - Tan Nguyen
- Department of Family Medicine, UC Irvine School of Medicine
| | | | - Tien Lam
- UC Irvine, California, United States
| | - Uyen Mai
- UC Irvine, California, United States
| | | | | | - Cynthia Haq
- Department of Family Medicine, UC Irvine School of Medicine
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23
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Tharmaratnam T, D'Urzo A, Cazzola M. Medical knowledge about COVID-19 is travelling at the speed of mistrust: why this is relevant to primary care. Fam Pract 2022; 39:988-991. [PMID: 35079783 PMCID: PMC9383313 DOI: 10.1093/fampra/cmac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Anthony D'Urzo
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
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24
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Leslie M, Pinto N, Fadaak R. Improving Conversations With COVID-19 Vaccine Hesitant Patients: Action Research to Support Family Physicians. Ann Fam Med 2022; 20:368-373. [PMID: 35443974 PMCID: PMC9328713 DOI: 10.1370/afm.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022] Open
Abstract
Vaccination delivery and efforts to counter vaccine hesitancy have become focal issues for family medicine teams as the COVID-19 pandemic has evolved. Conducting action research, our team developed an interactive web-based guide to improve clinical conversations around a broad range of vaccine hesitancies presented by patients. The paper presents a step-by-step account of the guide being codesigned with family physicians-its targeted end users-in a process that included validation interviews; role-play interviews; and user-tested design. The validation interviews sought to understand the pragmatic realities of vaccine hesitancy in family medicine clinical practice relative to relevant psychological theories. The role-play interviews drew out conversational strategies and advice from family physicians. The principles of motivational interviewing-an evidence-based approach to vaccine hesitancy conversations that supplements information deficit approaches-were used to codesign the content and layout of the guide. User counts, stakeholder engagement, and web-based analytics indicate the guide is being used extensively. Formal evaluation of the guide is presently underway.Originally published as Annals "Online First" article.
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Affiliation(s)
- Myles Leslie
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Pinto
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Raad Fadaak
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
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Lo CH, Chiu L, Qian A, Khan MZ, Alhassan HA, Duval AJ, Chan AT. Association of Primary Care Physicians Per Capita With COVID-19 Vaccination Rates Among US Counties. JAMA Netw Open 2022; 5:e2147920. [PMID: 35142834 PMCID: PMC8832176 DOI: 10.1001/jamanetworkopen.2021.47920] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines the association between the number of primary care physicians (PCPs) per capita and COVID-19 vaccination rates among US counties.
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Affiliation(s)
- Chun-Han Lo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Leonard Chiu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna Qian
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | | | - Hassan A. Alhassan
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Axel J. Duval
- Department of Medicine, Rutgers New Jersey Medical School, Newark
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Day P, Strenth C, Kale N, Schneider FD, Arnold EM. Perspectives of primary care physicians on acceptance and barriers to COVID-19 vaccination. Fam Med Community Health 2021; 9:fmch-2021-001228. [PMID: 34740897 PMCID: PMC8573291 DOI: 10.1136/fmch-2021-001228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to examine the perspectives of primary care physicians in Texas around vaccine acceptance and potential patient barriers to vaccination. National surveys have shown fluctuating levels of acceptance for COVID-19 vaccination, and primary care physicians could play a crucial role in increasing vaccine uptake. DESIGN This study employed a cross-sectional anonymous survey design to collect data using an online questionnaire. Participants were asked about vaccination practices and policies at their practice site, perceptions of patient and community acceptance and confidence in responding to patient vaccine concerns. SETTING From November 2020 to January 2021, family medicine physicians and paediatricians completed an online questionnaire on COVID-19 vaccination that was distributed by professional associations. PARTICIPANTS The survey was completed by 573 practising physicians, the majority of whom identified as family medicine physicians (71.0%) or paediatricians (25.7%), who are currently active in professional associations in Texas. RESULTS About three-fourths (74.0%) of participants reported that they would get the vaccine as soon as it became available. They estimated that slightly more than half (59.2%) of their patients would accept the vaccine, and 67.0% expected that the COVID-19 vaccine would be accepted in their local community. The majority of participants (87.8%) reported always, almost always or usually endorsing vaccines, including high levels of intention to recommend COVID-19 vaccination (81.5%). Participants felt most confident responding to patient concerns related to education about vaccine types, safety and necessity and reported least confidence in responding to personal or religious objections to COVID-19 vaccination. CONCLUSIONS The majority of the physicians surveyed stated that they would receive the COVID-19 vaccination when it was available to them and were confident in their ability to respond to patient concerns. With additional education, support and shifting COVID-19 vaccinations into primary care settings, primary care physicians can use the trust they have built with their patients to address vaccine hesitancy and potentially increase acceptance and uptake.
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Affiliation(s)
- Philip Day
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chance Strenth
- Department of Family and Community Medicine, UT Southwestern Medical School, Dallas, Texas, USA
| | - Neelima Kale
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - F David Schneider
- Department of Family and Community Medicine, The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
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Newton WP, Baxley E, Magill M. Learning From COVID-19: System Blindness to Primary Care. Ann Fam Med 2021; 19:282-284. [PMID: 34180855 PMCID: PMC8118485 DOI: 10.1370/afm.2705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Warren P Newton
- American Board of Family Medicine, Department of Family Medicine, University of North Carolina;
| | | | - Michael Magill
- American Board of Family Medicine, Department of Family and Preventive Medicine, University of Utah
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