Preventing a Twindemic

Preventing a Twindemic

How UCSF Health’s Office of Population Health is collaborating with primary care providers and community ambassadors to increase flu vaccinations for a historically under-vaccinated population

In a year dominated by concern around COVID-19, the 2020-21 flu season received comparatively little public attention. Yet last year, as fall approached, UCSF Health’s Office of Population Health felt a growing urgency.

“UCSF takes flu immunization very seriously every year,” recalls Gina Intinarelli, UCSF Vice President and Chief Population Health Officer, “but last year there was significant concern about COVID-19 and flu co-infection.” Fear of a “twindemic” was compounded by the knowledge that communities of color hardest hit by COVID-19 – Black/African-American, Pacific Islander, Chinese, Latinx, and Indigenous populations – are also those who have consistently encountered barriers to flu vaccination.

Intinarelli heads UCSF Health’s Office of Population Health (OPH) which has been working to address various health disparities for many years, including disproportionately high rates of flu and hypertension in the Black/African American population, and low rates of advanced care planning in Latinx populations. As flu season approached, the OPH outreach team managed by Kristin Gagliardi, took steps to implement specific interventions addressing some of the most common drivers of under-vaccination in the Black/African American population: lack of access to vaccines and vaccine hesitancy.

Accelerating the timeline

Working under the threat of a predicted late-year surge in COVID-19 cases, OPH outreach teams understood that the success of their efforts hinged on timing. In non-pandemic years, a joint initiative between OPH and UCSF Primary Care would start placing automated calls in January to primary care patients who had not yet received a flu vaccine. But the group opted to accelerate their timeline and start in the fall with a focus on engaging the Black/African American population. By starting earlier, the health system would have more time to offer education and coordination for those who have historically lower vaccination rates due to justified mistrust, or issues accessing care. By December 2020 – a full month before they would have normally begun – all automated vaccine outreach calls were complete.

Increasing access

In parallel, the outreach team made accessing the flu vaccine easier. Working with UCSF primary care clinics, they established and publicized the availability of COVID-safe drive-through and weekend clinics throughout San Francisco and Oakland so patients could get vaccinated without having to travel far from home or take time off work. To further build awareness, patients being seen at primary care clinics received custom after-visit-summaries offering guidance on how to access flu vaccines through community providers and pharmacies. Outreach even extended to specialty care settings, where physicians screened whether patients had received the flu vaccine, and staff offered vaccination scheduling assistance.

Partnering with the community

As follow up, the outreach team developed MyChart messaging for Black/African American UCSF patients who had actively declined the flu vaccine. Crafted with input from community members involved in the Black Health Initiative, which brings together patient and community stakeholders to promote culturally tailored engagement activities, the messages acknowledged the personal and historical mistrust that exists around vaccines, providers, and the health system. They also included offers of direct support, education, and information on vaccine availability. As of mid-February 2021, over 950 Black/African American patients received these messages.

Promising results

Early results show flu vaccination rates among Black/African American patients increased 12.7 percent from the period prior to the outreach. In addition to this encouraging uptick, the outreach team sees opportunities to scale its intervention strategy. “By reaching out sooner, clinics had the opportunity to have personal conversations with their patients, specifically those we serve who experience known barriers to care,” observes Gagliardi, adding “These are tactics we will use in our COVID-19 vaccine outreach efforts, both for marginalized and general populations.”

Sara Coleman, Director of Population Heath Quality Programs, leads the outreach team’s efforts to identify disparities and prioritize interventions. She points to community partnerships as the key to effective outreach, noting, “Our efforts have more power when we partner with community-based organizations like the Black Health Initiative. Not only does coordinating with community members help us develop messaging that resonates with underserved populations, but it allows us to reach patients where they are – beyond the four walls of the clinic.”

Looking ahead

OPH was able to quickly operationalize a robust and expedited community outreach effort in the midst of the pandemic thanks in large part to its longstanding focus on equity. “We expanded our flu efforts and infrastructure to provide additional immunizations, added a drive-through option, and built the necessary data systems to track progress,” recounts Intinarelli, “all with an eye toward equity and addressing health disparities.”

OPH is already applying the lessons learned from this successful outreach initiative to the unprecedented COVID-19 vaccination effort that lies ahead. In partnership with community ambassadors, outreach teams are actively engaging with individuals who are eligible for the COVID-19 vaccine and building lasting and trusting community relationships.