Infectious Disease

Access to vaccines and training from providers helped overcome the reluctance of our patients

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One of the challenges healthcare providers face when administering COVID-19 vaccines is reluctance to vaccinate, especially among disadvantaged populations.

The HHS reports that a lower percentage of the black and Hispanic population have received a COVID-19 vaccination than the “non-Hispanic white population”. This is a worrying trend, especially considering that end-stage kidney disease disproportionately affects color communities. Of the dialysis patients, 34% are black patients and 19% are Hispanic patients.

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Fair distribution

By the end of April, more than 70% of DaVita patients nationwide had received at least one vaccine dose. To achieve this COVID-19 vaccination rate in our diverse patient population, DaVita has put in place an equitable distribution strategy based on patient experience and convenience. The strategy included providing direct access to vaccines in every DaVita dialysis center and providing extensive multimedia educational resources.

DaVita and other dialysis providers worked closely with the Trump and Biden governments, the CDC, and state governments to ensure dialysis patients had direct and convenient access to COVID-19 vaccines. As a result, the kidney care community delivered hundreds of thousands of COVID-19 vaccines directly to patients with ESKD in dialysis centers across the United States in the first six months of this year.

As a provider of kidney treatment to more than 110,000 black patients, ensuring equal access to the vaccine has been a primary focus for DaVita, especially in rural areas and underserved communities. Through DaVita’s vaccine efforts, we have significantly narrowed the vaccination rate gap between this patient population and white patients. However, our goal remains to close the overall vaccination hesitation gap.

Vaccine hesitate

To put this in perspective, high rates of hesitation resulted in a more than 40% discrepancy between vaccination rates for white and Asian-American patients compared to black and Hispanic patients at the start of vaccination. This gap is completely closed for our Hispanic patients and is only 9% in black patients compared to white patients.

Jeffrey Giullian

Trusting the vaccine administrator improves overall vaccine confidence, according to the CDC. We largely attribute the high COVID-19 vaccination rate among DaVita patients to direct and convenient access to the vaccine at trusted care centers. DaVita patients have received extensive education about COVID-19 and the vaccine from trusted caregivers. In most cases, the dialogue took place within an established patient-carer relationship. We believe that the existing relationship with each patient has helped break down barriers and made it possible to discuss common causes of hesitation. Direct training at the center was combined with telephone follow-up support and access to multimedia teaching materials.

In addition, we found that some hesitant patients became more receptive to the vaccine when they witnessed and talked to other patients receiving the vaccine.

By giving patients access to the vaccine at their familiar treatment location, there is no need to navigate to appointments and the risk of traveling to third-party vaccination centers. Dialysis centers are well prepared to give COVID-19 vaccines as centers routinely provide flu, pneumonia, and hepatitis vaccines. Patients could also receive the vaccine during their dialysis appointments, saving time and ensuring post-vaccination monitoring.

During the COVID-19 pandemic, DaVita has cared for patients who are at high risk of complications related to COVID-19 due to multiple chronic comorbidities. Successful vaccination of patients with ESKD against COVID-19 demonstrates the unique role dialysis centers can play in addressing health inequalities. As we begin to achieve something called a “new normal,” our pursuit of health equity in patients with kidney disease continues.

References:

https://aspe.hhs.gov/system/files/pdf/265511/vaccination-disparities-brief.pdf. Retrieved July 8, 2021.

www.whitehouse.gov/briefing-room/statements-releases/2021/03/25/fact-sheet-biden-administration-announces-historic-10-billion-investment-to-expand-access-to-covid-19- Vaccines-and-Vaccine-Building-Trust-in-Most-Affected-and-High-Risk-Communities /. Retrieved July 8, 2021.

Jeffrey Giullian, MD, MBA, FASN, is Chief Medical Officer of DaVita Kidney Care and a member of the Editorial Advisory Board for Nephrology News & Issues. He can be reached at [email protected].

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