The UCHealth AF Williams Family Medicine Clinic – Central Park is a busy place. Hundreds of patients are seeking care there and it is not surprising that some patients have not yet received vaccinations to protect against COVID-19.
The good news is that UCHealth makes it easy for patients to get one. In most cases, health care providers can easily check a patient’s vaccination status in the electronic health record and, if necessary, help determine a time for an injection at a UCHealth vaccination site. At AF Williams, the process is even simpler. Thanks to a UCHealth pilot program, the clinic has stocks of the one-time Johnson & Johnson vaccine and willing patients can receive an injection on the spot.
The bad news is that health care providers at AF Williams consistently see that patients are still hesitant to get vaccinated against COVID-19.
Overcoming the hesitation about the COVID-19 vaccine
“I’m amazed that every day in the clinic I come across a few patients who have not yet been vaccinated,” says Dr. Corey Lyon, a family medicine specialist at AF Williams and an associate professor in the Department of Family Medicine at the University of Colorado School of Medicine.
Lyon said he is checking the electronic health record to verify the vaccination status of any patient he sees. If a patient has received the vaccine but the system is not yet registering the information, Lyon offers to help them register it – an important help, as a person may need to show proof of vaccination for a job or other activity. For unvaccinated patients, the Lyon electronic check offers an opportunity.
“It opens the door to finding out why,” he said.
Ongoing health care stress
It is the key question of the ongoing COVID-19 pandemic. About 72% of those who qualify are fully vaccinated in Colorado. But another 22% of those who qualify have not even received a single dose, leaving them unprotected at a time when the delta strain of the virus continues to cause an alarming increase in Colorado cases and hospitalizations. The consequences for society and for healthcare are far-reaching.
For example, at UCHealth hospitals, as of early November, unvaccinated patients accounted for more than three-quarters of all patients hospitalized for COVID-19 and more than 90% of patients with COVID-19 in ICUs and on ventilators. . That, in turn, stresses health professionals and the resources available to patients who need treatment for other conditions.
Given these facts and the human toll of the disease, why do so many people remain “reluctant” or downright resistant to getting an injection with a proven track record of protection?
No easy task to unravel reasons for hesitation about COVID-19 vaccines
That is not easy to answer. Lyon said he is advocating for getting the vaccine and is investigating the reasons why some patients refuse. Some fear side effects from the vaccine — usually the result of the vaccine stimulating a short-lived immune response — which Lyon is trying to eliminate.
“During these times, we look at why side effects occur and their short-term nature, usually only 24 to 48 hours, and the long-term benefit of vaccination and protection against COVID,” he said.
Others have questions about how Pfizer and Moderna’s messenger RNA (mRNA) vaccines work and what the vaccine does to the body.
“My explanation to patients includes how the vaccine gets into our muscle cells and helps our cells make a protein that resembles a COVID protein,” Lyon said. “At that point, when our body sees that protein, it makes antibodies against it. If you are then exposed to COVID, your antibodies are already made to recognize the COVID protein and stimulate an immune response. Once the mRNA helps our cells make that protein, it quickly disappears.”
But Lyon said he and his colleagues often get frustratingly vague responses from the hesitant vaccines.
“What we’re hearing is that a lot of patients don’t really have a good reason why they don’t want the vaccination,” Lyon said.
In some cases, the scientific evidence supporting vaccine effectiveness fails to counter a cacophony of claims and accusations on the internet, social media and community chatter about unproven risks posed by the injection, he added.
“They can be overwhelmed and confused by ‘information’ out there from probably unreliable sources,” Lyon said. “If you peel the layers off that onion, you often find a lot of intricate information that clouds their ability to say ‘yes’.”
Not surprisingly, some patients’ deep skepticism toward authority plays a role in some patients’ vaccine resistance, Lyon said. “They may be more concerned about ensuring they maintain their civil liberties than about doing something they are told or expected to do.”
Countering the opposition
But Lyon added that skepticism or outright resistance to vaccination hasn’t stopped him or his colleagues from cautiously urging their patients to reconsider their stance.
“If they’re concerned about the vaccine that I know is coming from unreliable sources, I’ll let them know I hear what they’re saying and understand,” he said. “But then I try to give them some confidence in my knowledge and let them know that I have devoted my last 18 months to treating COVID. I’ve been keeping up with the scientific literature and would be happy to clarify any questions they might have.”
AF Williams is also a training location for University of Colorado School of Family Medicine residents. Part of their training is learning to communicate effectively with patients. Lyon said residents practice motivational interviews to uncover the “core reasons” for patients’ unhealthy behaviors, such as smoking, and identify what it takes to motivate them to change their mind. The residents use the same technique on patients who are reluctant to receive the COVID-19 vaccine.
In any case, Lyon added, he is avoiding using scare tactics, such as telling hesitant or resistant patients about the serious consequences, such as prolonged stints on a ventilator or death, that could await them if they are not vaccinated against COVID-19. The approach just doesn’t work, he said, especially for those who are vehemently opposed to getting the vaccine. An aggressive approach also carries the risk of “jeopardizing the relationship” that caregivers need to care for the overall health of their patients, he noted.
“Until people have had a personal experience with COVID-19, it’s not very effective to scare them about what might happen,” Lyon said.
The value of trusted sources when discussing hesitation about COVID-19 vaccines
However, providers can use their established relationships with patients to gently crack their shells of doubt about the vaccine, he stressed. The key is trust built over time.
“With patients I already have a relationship with, I talk about what the vaccine can do for all of us, and how the vaccine will protect not only them from COVID, but also their families, children, neighbors and communities,” he said. .
“I like to keep my posts short and sweet and focus on the benefits of vaccination and what prevents it,” added Dr. Matthew Simpson, who also practices family medicine at AF Williams. For example, Simpson said he explains the increased risk of serious illness that COVID-19 poses to his patients with chronic conditions, such as diabetes.
“I tell them that all the COVID vaccines we have are safe and effective and that because of their chronic illness I strongly recommended that they get the vaccine.”
keep the door open
It’s a welcome relief for health care providers at AF Williams when they successfully overcome their patients’ doubts and convince them to get vaccinated, Lyon said. The wins compensate for many conversations that resistant patients fail to convince.
“It’s getting tiresome because it makes so much sense to us as a way to treat this pandemic and reduce the infection rate, the positivity rate and the number of hospitalizations,” Lyon said. “Success fills your tank with a little bit of hope and you keep going and doing your best to keep your focus on the bigger goal.”
Regardless of their frustrations, the clinic’s caregivers will never close the door on discussions about COVID-19 and the vaccine, Lyon concluded.
“We let them know we’re always there,” he said. “The ball is in their court, and if they change their mind, we’re there for them.”