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December 1, 2020
Primary Care Transformation Primary Care Investment COVID-19
Rebecca Weintraub, MD
Christopher F. Koller, President
Asaf Bitton, MD, MPH
Back to The Milbank Blog
If it weren’t for the annual reminder from our primary care offices, how many of us would get our flu shots? And it’s more than a yearly nudge: we trust our primary care clinicians to keep an eye on our health and encourage us to initiate and follow healthy behaviors.
This trust should play a major role now in how we plan for an effective distribution of a COVID-19 vaccine in light of recent breakthroughs by Moderna and Pfizer. The difficulty of discovering a vaccine is eclipsed only by the difficulty of generating confidence in it and getting it to people. Federal, state, and local government plans for the enormous logistical challenge of COVID-19 vaccine distribution will be more successful if they account for the critical role of primary care in addressing these challenges.
Although the recent news about the Pfizer and Moderna vaccine candidates is positive, questions remain, including about their long-term efficacy, side-effect profiles, second-dose administration, storage requirements, and the timing of vaccine availability for large-scale, widespread adoption. Even with these issues resolved, effective vaccination campaigns rest on effective partnerships between government officials and clinicians. These partnerships are necessary to distribute vaccines, conduct education and outreach, safely administer a vaccine, and improve compliance.
The partnerships work better in some places than others. According to a Kaiser Family Foundation review of the initial state COVID-19 vaccine distribution plans submitted to the Centers for Disease Control, planning has been underway for months in some states and is just getting started in others. For instance, some states are using the Vaccine Allocation Planner for COVID-19 to allow departments of public health to plan for effective and equitable vaccine distribution. (This tool will also be important in the monoclonal antibody infusion prioritization.)
This approach reflects past practice. Adult flu vaccination rates in 2019 varied by about 75% between the highest and lowest performing states, and states with high vaccination rates tend to integrate primary care into their distribution strategies. They are repeating this for COVID-19. Our analysis of the details of the states’ COVID-19 distribution plans shows four of the five states with the highest 2019 adult flu vaccination rates have articulated specific roles for primary care physicians in identifying high-risk patients, reaching out to them, administering the dosages, and documenting the service. By contrast, three of the five states with the lowest rates have no mention of primary care physicians in their plans and the other two only list them along with other providers.
What does the role for primary care teams in vaccine distribution look like in successful states? The Maryland Primary Care Program (MDPCP) provides funding and technical assistance to primary care practices that are working to enhance care. Its 576 sites will play a role in the early rollout of immunizations thanks in part to their capacity to conduct their data-driven and clinical determinations of patient COVID risk. Through the MDPCP program and the state’s health information exchange, Maryland has consistently provided data to primary care practices about their attributed patients using a risk-stratification tool called the COVID Vulnerability Index.
In Rhode Island, the top-ranked adult flu vaccination state, officials of Coastal Medical, the state’s largest primary care group, viewed the flu vaccine administration this fall as a “dry run” for delivering a COVID-19 vaccine in high volume over a relatively short time frame while maintaining social distancing standards. Using state-purchased supplies and a well-honed statewide immunization registry, officials quickly devised and revised a drive-through model that worked very well for both patients and staff. Without suspending any existing services, Coastal’s leaders believe they can easily administer 600+ doses per day.
These examples show that strong, well-supported primary care teams can make vaccination distribution programs more successful for five reasons:
In the months to come, government officials should call on primary care teams to identify at-risk populations to prioritize for COVID-19 vaccines, provide advice on which vaccine is most promising for which patients, inform the public about possible side effects, administer the vaccines in certain instances, and help increase adherence rates. We trust them. Primary care practices will answer the call and help us navigate the uncertainties ahead.
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