Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

This module will be about intake and first contact with your patients around building um better vaccine communication. We'll be talking about setting the foundation for coordinated confidence-building communication with our patients. So, let's talk first about why intake matters. The first contact, uh, just a, a really high leverage point. Uh, the nurse or the medical assistant is often the first clinical touch point in the care continuum. Um, intake staffs are, are Uniquely positioned to spot early hesitancy because they'll hear um very uh frank um reasons for prior refusal, identify barriers such as cost or language or literacy issues, and really set the tone um by priming um for the clinician's recommendations with a unified message such as, you know, your doctor may wanna talk to you about vaccines today. Um, and they are able to set the tone early by small changes in how they communicate, small changes in the opening words which shape really the next steps. Um, some of these things might be normalizing vaccines as part of routine care, using plain language in every step, um, from intake all the way through to that conversation with the clinician, and then cueing the clinician with what you noticed. If you noticed that, um, maybe there was a literacy issue. Or a language issue that might um impede further communication around vaccines. So let's look at a case study. This is Mr. Lopez. Mr. Lopez is a 58-year-old Spanish-speaking um male with type 2 diabetes. He lives with his adult daughter and works a regular shifts. Um, he arrives, um, at a very busy US primary care clinic for a same-day urgent visit due to, um, new onset of acute foot pain. But as you know, he's being, um, the intake is ongoing, uh, it's been noticed, um, that he has a lot of overdue vaccinations and, and sort of a fragmented history of, um, vaccine documentations. Um, the last known documented vaccines were about 10 years ago, and as far as you can tell, there's no COVID-19 booster or shingles vaccine that has been administered. He's, his pneumococcal status is unclear, uh, because records from before that time are missing. And he has a migrant background, so some of his care may even been, been delivered in another country, which again um makes the ability to have up to-date records very, very problematic. Um, he does use the clinic almost exclusively for acute issues, so not necessarily a great patient for um having sort of regular routine care where you can sort of spend time around these issues like vaccination. So this is what the intake interaction might look like between Mr. Lopez and your medical assistant. The medical assistant asks, are you up to date on your vaccines? Mr. Lopez shrugs and says, you know, I got some shots back home. I'm not really sure. I heard that the shingles shots can make you really sick. Um, and the communication realities are, um, you know, Mr. Lopez may have a limited health literacy. Um, he does rely on his adult daughter to interpret rather than requesting a, a professional interpreter, and then there's always gonna be, um, translation, um, challenges with that. So, the workflow reality is that the medical assistant likely is at this point feeling unsure how to reply to Mr. Lopez's um response and sort of um would be worried about uh sort of falling behind in, in her tasks as well as potentially saying the wrong thing, which could uh lead to more hesitancy around um receiving vaccines. So let's ask a question um of the audience and see uh sort of how, how you're assessing this. Which factor do you think presents the highest risk of causing a missed vaccination opportunity uh or MOV uh for Mr. Lopez? A, prioritizing the acute issue, foot pain, while ignoring Ignoring preventive clinical flags. Bowing family interpretation to substitute for structured professional interpreter services. C. triage staff changing the subject due to the pressure and lack of confidence. Um, or D, fragmented past records from another country creating clinical inertia. Please lock in your responses via med app polling now. OK, great. So, let's talk about um some of the, the things that might have led to this particular scenario. Um, interestingly, 38 to 95% of all primary care encounters are documentable missed opportunities for vaccinating older adults or at-risk adults um because of some of these barriers. Some of the system and patient factors that may contribute to that. If you look at Mr. Lopez's scenario, um, specifically, it does illustrate how systemic pressures combined with patient-level disparities. So for example, in this case, um, low literacy. Uh, that's been strongly linked with lower vaccine confidence and underuse of preventive care. Um, acute-only utilization, that was very clear in, in Mr. Lopez's presentation. So visiting your doctors or your providers purely for symptomatic crises like foot pain means that preventive screening often is skipped and there's not necessarily enough time to address it or catch it up. Um, incomplete documentation. This is a big one. his migrant history and care in another country has led to missing immunization data, and it's often hard for providers to know how to fill those gaps. Staff hesitancy, um, lack of communication training can cause intake teams to drop conversation, cues under time pressure, or when they don't feel like they have the necessary skills to really be able to, um, address concerns like Mr. Lopez had. So, there are some safety and efficacy key concerns around um Vaccinations that are totally valid and, and really, you know, should be met and addressed um with clarity. Um, so Mr. Lopez said during his triage, uh, meeting, I've heard that the shingles shot can make you sick. Um, What it looks like in practice. Um, so, hesitation, referencing anecdotal evidence or myths and asking specific safety questions during vitals or screening. For Mr., in the Mr. Lopez's case, he referenced some anecdotal evidence. Um, but a lot of that anecdotal evidence, um, hesitation, specific questions around safety, um, they're, they're rational and they, they should be addressed. There's also sort of system vulnerability. Um, there's lack of brief, neutral validating techniques of intake. Um, staff often changes the subjects due to time pressure, and so, um, those again, um, you know, present a, a barrier to really being able to address safety and efficacy concerns, really that time pressure, um, as well as, uh, sort of not, not having all the knowledge, um, to be able to answer some of those questions. And then, um, The way to, to sort of combat that would be with a clinical move where you acknowledge and you flag um the concern. Uh, you know, I, I think something like saying to Mr. Lopez, it makes sense that you wanna be sure um to flag the specific worry even if it's not one you can address in the EHR for the clinician. Um, and to never argue or dismiss those concerns. So that might be a way to sort of address the system vulnerability, um, of not being able to in that moment and intake, uh, due to whatever pressures, due to time pressure, language pressure, literacy pressure, um, and or even sort of not being able to, uh, have the information to address, um, the, the Issue, but being able to flag that um and, and, and present that to the clinician, um, may be a way to, to combat that. There's often sometimes um another barrier um that I see quite frequently in my practice, uh, which is the perception that um they have a low risk for the infection that you're trying to prevent with vaccination. Um, so for example, um, you might hear something in your clinic like, I don't think I need it. I've never had flu before and I'm otherwise healthy, um, that you'll see very often, particularly in younger adults. Um, and so what it, what it, it really is expressing is sort of underestimating vulnerability, shrugging off suggestions, or stating that preventive care isn't really a priority for that visit. Um, So, the system vulnerability in that is that um risk may not be reframed in terms of age, underlying conditions, or the impact on the family and community. Those are the things that um if you frame them correctly, um, sort of really allows the patient to understand um their potential risk or vulnerability to that illness or disease. Um, The move um to address that potential system vulnerability of, of not reframing things within the right context is to, to do, in fact, refrain them. Tie vaccination to managing a chronic condition, for example. Uh, so in Mr. Lopez's case, you could say because you have, um, diabetes, protecting your lungs from pneumonia, um, is critical to staying out of the hospital. Uh, so putting it in context of why vaccination, um, might actually prevent, uh, Or, or be beneficial to their particular health within the context of their underlying conditions, um, or