The R.I. Department of Health is moving to include primary care doctors – the health care professionals with the most intimate knowledge of people’s medical histories and risk factors – in the COVID-19 vaccination effort as the rollout enters a new phase.
The thinking is that general practice doctors and pediatricians are best-suited to answer people’s questions about the vaccines, including their safety and effectiveness.
State health officials say the logistics of getting the vaccines distributed as efficiently as possible complicated the early inclusion of family doctors. For speed and efficiency, mass vaccination centers and regional clinics were initially established to get the community at large vaccinated. Community-based clinics, as well as retail pharmacies and municipal sites, put the vaccine into local neighborhoods.
But primary care doctors were untapped. The state is now preparing a plan to include them as officials shift their strategy away from mass vaccination sites. Gov. Daniel J. McKee has said the vaccination site at the Dunkin’ Donuts Center in Providence will close soon.
“People tend to trust their doctors. They tend to trust the people within their communities,” Ingrid Gardiner, the R.I. Department of Health vaccination operations lead for high-density communities, said in a recent meeting with the state’s vaccine subcommittee. “It’s important for those medical professionals to have a strong voice in getting people comfortable with the vaccines and encouraging them to get the
Dr. Michael Fine, a former R.I. Department of Health director, said the vaccination effort needs primary care doctors. About 20% of older Rhode Islanders – those over age 60 – have yet to be vaccinated. This is a group that remains at risk of serious coronavirus due to their age.
Every primary care doctor has a list of patients and can sort them by age and other health risks, Fine said. “To be honest, I never really understood why they weren’t front and center of this response, with the mass-vaccination sites for people who didn’t have primary care doctors.”
Logistics represented a challenge because the two most-used vaccines in Rhode Island – Pfizer and Moderna – must be stored at extremely low temperatures. And each vial contains multiple doses that must be used within a set amount of time once the vial is opened.
That means that primary care offices will have to schedule patients carefully to use the doses in time. But it’s not an impossible task, physicians said.
And now with vaccine hesitancy becoming an issue, a rapport with patients is needed.
In many communities, particularly cities with large numbers of people who are non-white, poor or traditionally not had regular access to medical care, vaccination rates remain below the state average.
Dr. Wilfredo Giordano-Perez, medical director of the Tri-County Community Action Agency in Johnston, advocated early for the inclusion of community health centers as vaccination sites. “Family medicine, in particular, because we’re caring for all ages in all families,” he said. “You’ve built this longstanding rapport with your patients and they trust you.”
Early on, his staff started calling every patient who was age 50 and older, asking them if they had any concerns or questions about the vaccine.
“It’s more important now than ever to get these vaccines into smaller practices and more primary care offices,” Giordano-Perez said. “We’re getting down to the people who are really hesitant, and they need the one-on-one reassurance.”
Dr. Yul Ejnes, a primary care physician with Coastal Medical Inc., said he's had many inquiries from patients about the vaccines, with people asking questions about its safety and particular concerns that they might have, such as whether they should get it after a flu or shingles vaccine.
He thinks the term "vaccine hesitancy" may be overstating the opposition to getting the vaccine. Most of his patients get their vaccines regularly but have questions about this one.
Given the spacing requirements for patients, the multi-dose vials and the 15-minute observation period after the vaccine, he thought it was appropriate that primary care doctors didn't get the vaccine earlier. It would have been difficult to administer. "I think we would have wasted a lot of vaccine," he said.
Mary MacDonald is a PBN staff writer. Contact her at Macdonald@PBN.com.
