The Rapid Evaluation of COVID-19 Vaccination in Emergency Departments for Underserved Patients Study

Abstract

Objectives Emergency departments (EDs) often serve vulnerable populations who may lack primary care and have suffered disproportionate COVID-19 pandemic effects. Comparing patients having and lacking a regular source of medical care and other ED patient characteristics, we assessed COVID-19 vaccine hesitancy, reasons for not wanting the vaccine, perceived access to vaccine sites and willingness to get the vaccine as part of ED care. Methods Cross sectional survey conducted from 12/10/2020 to 3/7/21 at 15 safety net United States EDs . Primary outcomes were COVID-19 vaccine hesitancy, reasons for vaccine hesitancy, and sites (including EDs) for potential COVID-19 vaccine receipt. Results Of 2575 patients approached, 2301 (89.4%) participated . Of the 18.4% of respondents who lacked a regular source of medical care, 65% used the ED as their usual source of healthcare. The overall rate of vaccine hesitancy was 39%; the range among the 15 sites was 28 to 58%. Respondents who lacked a regular source of medical care were more commonly vaccine hesitant than those who had a regular source of medical care (47 vs 38%, 9% difference, 95% CI 4 – 14%). Other characteristics associated with greater vaccine hesitancy were younger age, female gender, African American race, Latinx ethnicity, and not having received an influenza vaccine in the past five years. Of the 61% COVID-19 vaccine acceptors, 21% stated that they lacked a primary doctor or clinic to receive it; the vast majority (95%) of these respondents would accept the COVID-19 vaccine as part of their care in the ED. Conclusions ED patients who lack a regular source of medical care are particularly hesitant to COVID-19 vaccination. Most COVID-19 vaccine acceptors would accept it as part of their care in the ED. EDs may have pivotal roles in COVID-19 vaccine messaging and delivery to highly vulnerable populations.

COVID-19 vaccine coverage and factors associated with vaccine uptake among 23 247 adults with a recent history of homelessness in Ontario, Canada: a population-based cohort study

“…Although it is not possible to fully ascertain the mechanisms behind this lagged vaccination coverage from the study findings alone, past work has identified a range of hesitancy factors related to obtaining vaccination in people experiencing homelessness, including fear or mistrust of the vaccine, misinformation spread in media, uncertainties about personal risk of COVID-19, and elements related to access to health-care structures and trust within the patient–provider relationship. 21 , 23 , 24 , 31 , 32 Furthermore, systematic structural barriers commonly faced by people experiencing homelessness 33 possibly also acted as obstacles to COVID-19 vaccination in the study population. For instance, during the study period, many of the centralised provincial vaccination clinics required advanced scheduling of appointments through online websites or portals.…”

“…We obtained various sociodemographic, health-care usage, and clinical characteristics available in the health-care administrative databases that were found to previously be associated with vaccine uptake in people experiencing homelessness, identified as barriers to accessing and accepting COVID-19 vaccines in people experiencing homelessness or aligned with domains of the WHO 3C model for the determinants of vaccine hesitancy. 21 , 22 , 23 , 24 , 25 Characteristics and variable definitions are detailed in appendix 2 (p 18 ).…”

Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review

“… Fridman et al, 2021 , Teherani et al, 2021 , Akel et al, 2021 , Romer and Jamieson, 2021 , Keene Woods et al, 2021 , Ma and Ma, 2021 , Roberts et al, 2021 , Mondal et al, 2021 , Patil et al, 2021 , Rabin and Dutra, 2021 , Olanipekun et al, 2021 , Okoro et al, 2021 , Johnson et al, 2021 , Jacob et al, 2021 , Carson et al, 2021 , Bogart et al, 2021 , Rodriguez et al, 2021 , Ciardi et al, 2021 , Savoia et al, 2021 , Ofei-Dodoo et al, 2021 , Zheng et al, 2021 , Sharma et al, 2021 , Baniak et al, 2021 , Geana et al, 2021 , Hirshberg et al, 2021 , Rungkitwattanakul et al, 2021 .…”

Using rapid evaluation methods to assess service delivery changes: Lessons learned for evaluation practice during the COVID-19 pandemic

“…Recent literature also highlights increased attention to rapid research and evaluations in emergency contexts ( Rodriguez et al, 2021 ). Rapid approaches can provide contextually rich information on behaviours influencing service use.…”

“…Lessons can be drawn from previous infectious disease outbreaks such as Ebola in West Africa in 2014-2015 which necessitated rapid responses to facilitate control, treatment and prevention. An evaluation of UNICEF's Response to the Ebola Outbreak highlighted that rapid response strategies in health emergency contexts should be evidence-based and utilise robust data on the evolution of practice over time and on community knowledge, attitudes and perceptions (UNICEF, 2016) Recent literature also highlights increased attention to rapid research and evaluations in emergency contexts (Rodriguez et al, 2021). Rapid approaches can provide contextually rich information on behaviours influencing service use.…”