University of Wisconsin–Madison Medical College of Wisconsin

COVID-19 Vaccination Telephone Outreach: A Primary Care Clinic Intervention Targeting Health Equity

James F. Wu, MD; Martin D. Muntz, MD; Ann Maguire, MD, MPH; Anna Beckius, BS; Mandy Kastner, MPH; Brian Hilgeman, MD

WMJ. 2023;122(5):438-443

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Introduction: Equitable COVID-19 vaccine access is essential to ending the COVID-19 pandemic. In many instances, COVID-19 vaccination notification and scheduling occurred through online patient portals, for which socially vulnerable populations have limited access. Our objective was to reduce disparities in COVID-19 vaccine access for the Black and socially vulnerable populations unintentionally excluded by our health system’s patient portal-driven vaccine outreach through a telephone outreach initiative.

Methods: From February 1, 2021, through April 27, 2021, telephone outreach was directed towards patients aged 65 and older without patient portal access at a large urban academic general internal medicine clinic. Univariate and multivariate analyses between those who did and did not receive telephone outreach were completed to assess the odds of vaccination, accounting for outreach status, sex, age, race/ethnicity, payor status, social vulnerability index, and Elixhauser Comorbidity count.

Results: A total of 1466 patients aged 65 and older without active patient portals were eligible to receive the COVID-19 vaccine. Of these patients, 664 received outreach calls; 382 (57.5%) of them got vaccinated compared to 802 patients who did not receive outreach calls, of which 486 (60.6%) got vaccinated (P = 0.2341). Patients who received outreach calls versus those who did not were more likely to be female, younger, non-Hispanic Black, from high social vulnerability index census tracts, and have higher Elixhauser Comorbidity counts. Logistical analysis revealed an odds ratio (OR) with a nonstatistically significant trend favoring higher vaccination likelihood in the no outreach cohort with univariate analysis with no changes when adjustment was made for age, sex, race/ethnicity, payor, social vulnerability index, and Elixhauser Comorbidity count (univariate analysis: OR 0.88 [95% CI, 0.71-1.09]; model 1: OR 0.89 [95% CI, 0.72 – 1.10]; model 2 – 0.89 (0.72 – 1.11); model 3: OR 0.87 (95% CI, 0.70 -1.09)].

Conclusions: While our telephone outreach initiative was not successful in increasing vaccination rates, lessons learned can help clinicians and health systems as they work to improve health equity. Achieving health equity requires a multifaceted approach engaging not only health systems but also public health and community systems to directly address the pervasive effects of structural racism perpetuating health inequities.

Author Affiliations: Department of Medicine; Medical College of Wisconsin (MCW), Milwaukee, Wisconsin (Wu, Muntz, Beckius, Kastner); Division of General Internal Medicine, Section of Primary Care, MCW, Milwaukee, Wis (Muntz, Maguire, Hilgeman); Robert D. and Patricia Kern Institute for the Transformation of Medical Education, MCW, Milwaukee, Wis (Muntz).
Corresponding Author: James F. Wu, MD, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226; email; ORCID ID 0000-0001-7447-6173
Funding/Support: This research project won the first place research vignette at the annual scientific meeting of the Wisconsin chapter of the American College of Physicians (ACP), which provided a funding award to present the project at the 2022 National Internal Medicine Meeting. Funding from the Department of Medicine and Internal Medicine Residency Program of the Medical College of Wisconsin also was used to support the presentation of this project at the 2022 Society of General Internal Medicine (SGIM) Annual Meeting. JFW is supported by the National, Heart, Lung, and Blood Institute 1R38HL167238-01 grant and the American Society of Hematology Hematology Opportunities for the Next Generation of Research Scientists (HONORS) Award.
Financial Disclosures: JFW reports a funding award from Wisconsin ACP to present this project at the 2022 National Internal Medicine Meeting and funding from the Department of Medicine and Internal Medicine Residency Program of the Medical College of Wisconsin to present this project at the 2022 SGIM Annual Meeting.
Acknowledgements: The authors would like to acknowledge all those who participated in the COVID-19 telephone outreach initiative; M4 Ambulatory Course Directors Theresa C. Maatman, MD and Cynthia Kay, MD; Education Program Coordinator Mary Hoeschen, B;, and the Clinical Program Coordinator Taylor Melster, BS. They also would like to acknowledge Froedtert General Internal Medicine Clinic Manager Tammy Brissette, Section Chief for Primary Care Theodore MacKinney, MD, MPH, and the Center for Advancing Population Science of the Medical College of Wisconsin for their biostatistical support.
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