February 11, 2021

In the fall of 2020, Dr. Mike Farley, a clinical pharmacist for Winding Waters Community Health Center (Winding Waters) in Wallowa County, Oregon, prepared to administer the flu vaccine to a patient who had not received one in nearly 30 years. The patient, a military veteran, swore he would never get the vaccine again because, the last time he received one, he got very sick while deployed overseas. However, after building trust with Dr. Farley and getting more information about the quality of today’s vaccines, the patient agreed to the vaccination.

“It took the patient’s wife and primary care provider singing ‘Jingle Bells’ to distract him while I administered the vaccine, but I am incredibly happy that we were able to meet the patient where he was and help him make an informed choice to get immunized against the flu, especially with the risks of the COVID-19 pandemic,” said Dr. Farley. “In fact, he is a convert to vaccines now and keeps asking me when he can get his COVID-19 vaccination.”

Building Trust for the COVID-19 Vaccine in Rural Communities

Across the country, rural access clinics like Winding Waters have always worked to address vaccine hesitancy by understanding patients’ concerns and building trust with them through education and communication. However, with the COVID-19 pandemic, correcting misinformation and addressing vaccine hesitancy in rural areas has become an even more urgent priority.

According to the Kaiser Family Foundation COVID-19 Vaccine Monitor research, 35% of individuals living in rural areas said they would probably not, or definitely not, get a safe and free vaccine if available, compared to 26% of people living in urban areas. While there are many factors associated with an individual’s willingness to get a vaccine, access to, and availability of, COVID-19 vaccines in rural communities appears to be one of the biggest challenges.

“We are a frontier county, a place with winding mountain roads, low internet bandwidth, and inconsistent cell service,” said Nic Powers, CEO of Winding Waters. “As such, one of the biggest causes of vaccine hesitancy, which will continue to be a barrier as we start to distribute COVID-19 vaccinations, is access.”

Before COVID-19, one of the ways that Winding Waters began improving vaccine awareness and patient access is by sending six-person care teams, called vaccine pods, out to the most rural areas of the county. This helped to eliminate cost and transportation barriers for patients and made it easier for them to ask questions or get vaccinated. For example, in Imnaha, a remote town of just over 150 people, Winding Waters staff learned that the most effective way to disseminate information about local vaccination sites was by posting on a community Facebook group and partnering with the local tavern to help spread the word and host vaccine clinics. The trust Winding Waters has built as a result of finding new ways to reach and build relationships with patients in rural communities has taken time and will aid in the mass distribution of COVID-19 vaccinations when applicable.

“Currently, the local hospital is running mass vaccination events and distributing a majority of COVID-19 vaccinations. That looks likely to remain true for a while,” said Powers. “Our biggest vaccine focus is to partner with the hospital to get the COVID-19 vaccine to patients who cannot get to a mass vaccination site because they are homebound or have another disability. The equity piece in distributing these vaccines is really important, and Winding Waters is working to make sure everyone can access a vaccine.”

Using Technology to Scale Access with Vaccine Availability

As a member of the OCHIN network, Winding Waters has benefited from a number of clinical support services and electronic health record (EHR) tools designed to help providers optimize COVID-19 testing, vaccine delivery, patient follow up, and public health reporting. Even though state and federal guidelines for who qualifies to receive a COVID-19 vaccine are still limited, Winding Waters is already helping close the rural divide as part of Phase 1A of Oregon Health Authority’s vaccination rollout—distributing approximately 132 vaccine doses to the long-term care facilities in the county thus far. As the health center plans for wider interest and availability of the COVID-19 vaccine, it is exploring some of OCHIN’s other COVID-19 tools for managing mass vaccination and reaching patients who might not otherwise have access.

For example, as the clinic waits for more COVID-19 vaccines to become available, it is generating reports in OCHIN Epic EHR to create a list of patients who are eligible for the vaccine and using MyChart bulk messaging to send alerts to those patients about how to schedule an appointment with the local hospital. In addition, the clinic is exploring ways to further use MyChart virtual visits to deliver vaccines via home visits, where only a nurse would need to be physically present to administer the vaccine and a provider could be present on video as needed. Lastly, depending on how much vaccine supply the clinic receives, it may eventually use the OCHIN Epic COVID-19 Mobile App or other specialized vaccine enhancements that OCHIN has built to help providers administer mass testing and vaccination in underserved communities.

Powers said, “We will continue to mine our data, looking for patients in OCHIN Epic EHR who are eligible for the vaccine to improve access for all patients in our county. At the end of the day, overcoming vaccine hesitancy is about being patient-centered – listening to what the patient is trying to tell us and being flexible enough to ensure our team’s efforts benefit the patient moving forward.”

For more information about OCHIN’s COVID-19 related services and tools, which are available at no cost to OCHIN members, contact OCHIN’s business development team.

Every community faces unique barriers and concerns when it comes to vaccination—from misinformation to medical mistrust. If you are a provider conducting COVID-19 vaccine outreach, consider the following tips for guiding patients through the COVID-19 vaccination process and building community trust:

1. Determine the best communications tools and channels to reach all eligible patients who may have challenges accessing the information in your community, bearing in mind technology platforms, medical mistrust, language, or other considerations
2. Listen to patients to understand and directly address any concerns they have about the vaccine
3. Reassure patients about vaccine safety, efficacy, and importance to the community
4. Follow up promptly with appointment reminders and to monitor any adverse reactions
5. Identify gaps in vaccine access and develop localized strategies to connect with hard-to-reach patients

OCHIN members can access vaccination-related patient engagement resources via Ella. Additional recommended resources for community health centers and other providers can be found via the University of Florida’s Center for Public Interest Communications, Centers for Disease Control and Prevention (CDC), and the National Association of Community Health Centers (NACHC).