It was nothing short of miraculous that America’s health and public health communities mobilized so quickly to create a vaccine for COVID-19. Operation Warp Speed’s rapid research, development, and clinical trials produced remarkably effective vaccines that saved millions from severe illness and death. Now, more than 3 years later, we are in a new era of COVID: We know the virus is here to stay, so we now need to find a way to live with it.
Key to this effort will be implementing and adhering to our systems for prevention, including screening. In this context, I’m using “screening” to refer to clinicians asking patients whether they have gotten their latest COVID shot, and if they haven’t, discussing the benefits and potential risks. The CDC took an important step ahead of a potential winter surge and updated its vaccine administration recommendations in September, in addition to offering motivational interviewing tips as a resource for clinicians to discuss the COVID vaccine with patients.
Yet, as I’ve seen in my primary care physician’s (PCP) office and in talking to other PCPs, many clinicians are not screening for COVID vaccinations. COVID infections have serious comorbidities with other conditions like heart failure and coronary artery disease, so it would make perfect sense to talk about it with patients who have these conditions, as well as any other vulnerable populations. These discussions will go a long way toward normalizing care, getting ahead of new variants, limiting infections, and managing comorbidities.
I’m leading George Washington University’s Two in One: COVID + HIV Screening and Testing Model, and part of our charge has been to develop practical, research-informed recommendations for how clinicians can effectively screen for COVID-19 vaccinations. Our research illuminated several gaps that still exist, and my team formulated recommendations to close each gap, some of which are reflected in CDC’s motivational interviewing guide.
Gap 1: Patients Need More Reliable, Culturally Responsive Information
Some patients try to keep up with COVID vaccine and booster recommendations on their own, but clinicians can play a significant role in guiding them. Patients must navigate when and where to get vaccinated, while simultaneously being bombarded with conflicting recommendations and vaccine misinformation. So, conversations with patients can eliminate stigma and help them make informed decisions. Electronic medical records should include COVID vaccination status as well as prompts and recommendations for receiving regular COVID vaccinations and boosters.
It’s also vital to remember that culturally responsive communication is crucial in building comfort and trust between the patient and the clinician. “Culturally responsive communication” centers unique patient experiences and understandings of health and illness, recognizes the individual biases that clinicians may hold, and seeks to work productively with patients who are not typically represented or valued in the Western understandings of care.
Gap 2: Primary Care Clinicians Are Not Updated
Clinicians we interviewed informed us that they do not usually receive updated vaccine guidelines from the government or academic/professional organizations. As with patients, practitioners are individually responsible for keeping up with the latest information. Collaboration and partnership among local and state health systems and governments could help solve this issue. These partnerships could facilitate access to information from CDC, resource allocation, data analysis, policy development, and quality assurance, and would create a valuable feedback loop to help design a more effective screening system for the future.
Even if clinicians don’t have enough time during all visits to screen, they can still help patients receive the latest information by connecting them to online resources such as the federal government’s vaccine hub, or making COVID vaccination appointments for them.
Gap 3: PCPs Can’t Bill for Discussions
Current CDC guidelines direct patients to their healthcare team for any concerns regarding the COVID-19 vaccines. But with already time-limited visits, clinicians have little incentive to take extra time to navigate the difficult conversations around COVID vaccines since they are unable to bill for these discussions. So, creating a unique Medicare billing code could incentivize health delivery organizations to allow clinicians time for these important discussions.
Establishing COVID vaccine screening guidelines for the primary care setting is an important next step in living with COVID and encouraging people to get an annual vaccine. We already screen for a variety of other vaccinations, so adding COVID makes total sense. Keeping these crucial gaps in mind will help ensure that patients are receiving up-to-date, comprehensive information, while clinicians are able to make sure that all their patients are screened thoughtfully and sensitively.
Maranda Ward, EdD, MPH, is an assistant professor and director of equity in the Department of Clinical Research and Leadership at the George Washington University School of Medicine and Health Sciences, and the principal investigator of the Two in One: HIV + COVID Screening and Testing Model.
Disclosures
Ward disclosed the Two in One: HIV + COVID Screening and Testing Model is funded by Gilead Sciences, Inc.
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