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News: Program brings vaccine to where patients are : Emergency Medicine News

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COVID-19 vaccine, social ME

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We treat a large number of people with issues related to homelessness, chronic non-communicable diseases, psychological crisis and substance abuse at St. Vincent’s Hospital Melbourne, a large tertiary public teaching hospital in central -city of Melbourne, Australia. Our most frequent emergency patients are disproportionately affected by these primarily social problems with increasing prevalence.

Almost a quarter of all emergency visits to Australia last year were from people living in the most socio-economically deprived areas, according to the Australian Institute of Health and Welfare. (https://bit.ly/3rOn5KK.)

Australia has been fortunate to circumvent much of the scale of COVID-19 mortality suffered by our colleagues overseas, but strict and prolonged lockdowns in Victoria and New South Wales have contributed to an increase in mental illness, family violence, housing instability, drugs and alcohol. addiction, with implications for emergency department visits and the continued provision of safe healthcare, including vaccination against COVID-19.

It soon became apparent in our emergency department that vaccination among our heavy users was lagging behind the general population – 20% less. (Emerg Med Australia. October 8, 2021; doi:10.1111/1742-6723.13883; https://bit.ly/3dA7iqx.) We implemented an opportunistic vaccination program to address this issue in the emergency department, which prioritized Indigenous Australian patients, homeless and living with substance abuse and dependency issues, domestic violence and other social vulnerabilities.

Countering Misinformation

Most of our unvaccinated patients are not averse to vaccination, offering an arm for an ER prick when offered an opportunistic vaccine, but a number of challenges in safely obtaining a COVID-19 vaccine persist. Vaccination centers often require advance reservations and a commitment to a time slot of at least a week, which is difficult to meet in the face of competing priorities such as unstable accommodation, language barriers, cash work addiction and the threats of domestic violence. Booking vaccinations also relies heavily on online systems inaccessible to someone without reliable internet or a smartphone with data.

We initially implemented opportunistic vaccination in the emergency department to help those who couldn’t get vaccinated, rather than those who wouldn’t, and also found that a simple conversation with a committed clinician and a cup of hot coffee was enough advice to change the minds of many people who were hesitant about vaccination. Promoting good health literacy during the pandemic has proven difficult, and many patients describe not really knowing who or where to get accurate or personalized information about the vaccine, struggling to differentiate between medical sources. metastatic misinformation disguised as fact on social media.

We can also address personal concerns and contextualize the risk to the emergency department in a way that the patient can directly understand. Much has been made, for example, of the risk of post-vaccine venous thromboembolism, but explaining that you are twice as likely to be struck by lightning as to have a blood clot gives an accessible perspective. Conversations about opportunistic vaccination in the emergency department have proven to be a valuable reminder of individual health autonomy for people living with family members who verbally oppose vaccination.

Opportunistic vaccination is facilitated with the support of the nearby vaccination center which maintains dose storage and cold chain means to avoid wastage. A number of prepared vaccination doses are provided to the emergency department each morning where they are kept in the department’s medication room at room temperature for up to six hours. Once an eligible patient is identified in the emergency department, the vaccinating clinician can walk into a booth with the dose ready to counsel, consent and vaccinate the patient in a single interaction.

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Unused vaccines can be exchanged for newer doses from the vaccination center before they expire to facilitate vaccinations throughout the day. Immunization governance, vaccinator training, and administrative requirements vary by location, although the majority of systems rely on local documentation and electronic databases to record immunizations, accessible from the emergency department .

The unequivocal value of opportunistic vaccination in the emergency room re-emphasizes the need for social emergency medicine as a subspecialty addressing the needs of the most vulnerable and marginalized people in society, who are universally more likely to be sicker and to seek health care in an emergency. Even before COVID-19, the remit of emergency departments already extended beyond the realm of immediate provision of physical health care in response to the growing number of patients with complex and chronic complaints and an ever-increasing range broader biopsychosocial conditions.

The global outcomes seen with COVID-19 and socioeconomic disadvantage over the past two years do not illustrate new patterns of morbidity and mortality, and many of the public health issues associated with the pandemic are not without previous ; structural racism within health systems, inaccessibility of health information, and the impact of inadequate living conditions on disease acquisition and care-seeking behaviors are long-standing issues, and the pandemic merely cast a magnifying glass over the gaping chasms of existing health inequalities.

The detrimental impact of the pandemic will last for decades, but the legacy and lessons learned from COVID-19 must be catalysts for conversation and action on the social and cultural determinants of global health in clinical practice.

Dr Simons thank you Jennie Hutton, BMBS, MPH, and Sally Harding, BPharm, for their role in setting up the opportunistic vaccination program at St. Vincent’s Hospital in Melbourne.

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Dr Simonsis an Emergency Department Registrar working in Melbourne, Australia. She is trained in the UK with postgraduate studies in global public health at University College London and an academic interest in the determinants of health, integrating social justice perspectives and advocacy into emergency clinical practice. for socially vulnerable people. Follow her on Twitter@SarahNSimons.