Public Health Detailing as a Tool for Increasing COVID-19 Vaccine Confidence and Access and Addressing Racial Inequities

Posted on March 5, 2024 by Nina Shabbat, Michelle Dresser, Lysa Petrsoric, Avani Bhatnagar Ansari, Michelle Morse

This entry is part 15 of 16 in the series Mar 2024

A Public Health Detailing campaign focused on building confidence in and access to the COVID-19 vaccines was a key part of reducing racial inequities in COVID-19 vaccination rates across New York City.

In the spring of 2021, significant racial inequities in COVID-19 vaccination rates in New York City (NYC) emerged, owing to a history of community disinvestment and structural racism. To address these inequities, the New York City Department of Health (DOHMH) undertook a multi-pronged, community place-based strategy[1] to build confidence in and ensure equitable access to COVID-19 vaccines. In our latest publication, “Using Public Health Detailing to Increase Access and Confidence in COVID-19 Vaccines and Reinvest in Disproportionately Impacted NYC Communities” we describe one part of this strategy in-depth.

Read the article in JPHMP

Public Health Detailing (PHD) is a provider education and outreach program based off of the pharmaceutical detailing model.[2] As part of the program, DOHMH outreach representatives (reps) make in-person visits to healthcare providers’ offices to promote specific public health recommendations and offer resources to assist in the implementation of these recommendations. The PHD program operates out of DOHMH and has been used in recent years as a strategy to address a host of public health challenges. Building upon this existing infrastructure, DOHMH rapidly stood up an emergency detailing campaign to help better equip primary care providers to promote COVID-19 vaccination and improve access to vaccination by sharing information with practices seeking to become vaccination sites.

With a close eye on racial inequities in vaccination rates, the PHD team used hyperlocal vaccination data and an equity framework in the selection of its priority neighborhoods for this campaign, focusing initially on selected sections of the Bronx and Brooklyn that were disproportionately impacted by COVID-19 as defined by the NYC Taskforce on Racial Inclusion and Equity. The campaign later expanded to include parts of all five NYC boroughs, with an emphasis on neighborhoods with a large Black population and low vaccination rates.

PHD staff were quickly deployed to train a team of outreach reps in the detailing approach and COVID-19 disease and vaccine content. Importantly, the assigned reps were recruited from the City’s contact tracing program, Test and Trace; these reps came from diverse NYC communities and generally spoke at least one additional language, making them credible messengers in historically marginalized communities. Following a brief training, reps conducted outreach visits to primary care practices to share a series of key recommendations that promoted vaccination and the importance of bi-directional patient and provider communication.

To assist providers in having conversations with their patients and educating patients on the safety, efficacy, and need for vaccination, reps offered a suite of DOHMH resources, including provider communication guides and patient education materials. In addition to sharing these key messages, another important role for the outreach reps was to serve as a feedback loop for DOHMH leadership with respect to community providers. Information obtained about challenges on the ground was shared with DOHMH leadership regularly and fed back into the agency’s emergency response.

WHAT WE FOUND

Our team conducted 2873 detailing sessions at 1281 sites from May 2021 to March 2022. Over time, we found that patient barriers to vaccination were consistent and focused primarily on a lack of trust in the vaccine development process, concerns around vaccine safety, and a lack of perceived need for the vaccine. In contrast, provider barriers to offering vaccination changed over time, first focusing on the lack of appropriate equipment for storage and handling of the vaccine and later to a preference for referring patients out. A number of interesting trends were also verbally reported to reps including, for example, a handful of providers arguing without supporting data that immunity achieved via infection was more robust than vaccine-acquired immunity.

Purposefully, this campaign was conducted in neighborhoods where other community engagement activities were occurring. Thus, it is not possible to quantify the impact of PHD alone; however, by the time the campaign concluded, neighborhoods that were identified as being disproportionately impacted by COVID-19 showed almost no disparities in vaccination rates compared with neighborhoods that were less impacted.¹

Lastly, by reinvesting in historically disadvantaged communities and working with trustworthy messengers to provide resources and support to primary care providers when they were very much needed, PHD also helped to build relationships between DOHMH and community-based providers, some of whom may not have been formally engaged with public health agencies. These connections are particularly important as they may outlast the current campaign, help address COVID-19 recovery, and potentially help prepare for future emergencies. These factors make the program an important piece of a larger community outreach initiative and, coupled with the program’s flexibility, one that is easily adaptable by other public health departments. To learn more, please check out our full publication, available here.

[1] Ige O, Watkins J, Pham-Singer H, Dresser M, Maru D, Morse M. Embedding health equity in a public health emergency response: New York City’s COVID-19 vaccination experience. NEJM Catalyst. 2023;4(2):1–14.

[2] Larson K, Levy J, Rome MG, Matte TD, Silver LD, Frieden TR. Public Health Detailing: a strategy to improve the delivery of clinical preventive services in New York City. Public Health Rep. 2006;121(3):228–234.

Author Profile

Nina Shabbat, Michelle Dresser, Lysa Petrsoric, Avani Bhatnagar Ansari, Michelle Morse: Nina Shabbat, MPH, is the Evaluator for the Public Health Detailing Program at the NYC Department of Health and Mental Hygiene. In this role, she leads the planning and execution of evaluation and program monitoring activities. Previously, she worked as a researcher and evaluator, focusing on organizational interventions that improve healthcare delivery and patient experience.