More Than a Health Fair: Preventive Health Care During COVID-19 Vaccine Events

Federal Practitioner. 2022 November;39(11)a:454-458 | doi:10.12788/fp.0328

November 10, 2022|Federal Practitioner

Kathryn M. Ryder, MD, MS;Mary L. Ricardo-Dukelow, MD;Ashni Patel, PharmD;Chaz Barit, PharmD;Gloriann Watson, PharmD

Background: During the initial phase of the COVID-19 pandemic, facilities transformed some medical care to virtual appointments. There was a subsequent decline in chronic disease screening and management, as well as cancer screening rates.

Observations: COVID-19 vaccine events offered an opportunity to provide face-to-face preventive care to veterans, and mobile vaccine events enabled us to reach rural veterans. In this quality improvement project, we partnered with state and community organizations to reach veterans at large vaccine events, as well as in rural sites and homeless housing. The program resulted in the successful provision of preventive care to 115 veterans at these events, with high follow-up for recommended medical care. In all, 404 clinical reminders were completed and 10 new veterans were enrolled for health care. Important clinical findings included an invasive colorectal cancer, positive HIV point-of-care test, diabetic retinal disease, uncontrolled hypertension, and depression.

Conclusions: Vaccine events offer a venue for chronic disease screening, referral, and cancer screening.

Of the 166 vaccines given, 73 were for COVID-19. Besides vaccination,

204 clinical reminders total were completed at the event (Table 2). Hypertension was the most common reminder with 52 completed; 29 veterans had BP in the hypertensive range. BP cuffs were provided to 19 veterans and CPS follow-up appointments were scheduled for 24 veterans. Of 22 homeless and food insecurity screens, 4 were positive and services and resources were provided. One veteran obtained emergency housing the same day.

Veteran follow-up or completion

of recommended services allowed 34 more reminders to be closed (Table 3), with high follow-up for referrals (76%). Within 3 months of an initial BP screen, 22 veterans had at least 1 follow-up with a pharmacist, 17 had BP controlled, and the BP of 5 veterans remained elevated. Screenings revealed abnormal health findings: CRC screening revealed CRC, 6 of the 11 completed laboratory results had an actionable finding, and all diabetic retinal referrals showed retinal disease. Poor follow-up was seen for diabetic high-risk foot referrals and HIV care.

Discussion

This program provided evidence that adding preventive screenings to vaccine events may help reach veterans who may have missed important preventive care due to the COVID-19 pandemic. The involvement of clinical informatics service allowed the outreach to be targeted to communities with incomplete clinical reminders. Interventions that could not be completed at the event had high levels of follow-up by veterans with important findings. The presence of a physician or nurse and a CPS allowed for point-of-care testing, as well as entering orders for medication, laboratory tests, and consultations. The attendance by representatives from the Vet Center, suicide prevention, and homeless services allowed counseling regarding benefits, and mental health follow-up. We believe that we were able to reach communities of veterans with unmet preventive needs and had higher risk of severe COVID-19, given the high numbers with open clinical reminders, the number of vaccines provided, and the high percentage of racial and ethnic minority veterans at events in the community. Our program experience provides some evidence that mobile and pop-up vaccination clinics may be beneficial for screening and managing chronic diseases, as proposed elsewhere.^21-24

Strengths of this intervention include that we were able to show a high level of follow-up for recommended medical care as well as the results of our interventions. We have found no similar articles that provide data on completion of follow-up appointments after a health fair. A prior study showed only 23% to 63% of participants at a health fair reported having a recommended follow-up discussion with doctors, but the study reported no outcome of completed cancer screenings.²⁵

Limitations

Weaknesses include the fact that health fair events may reach only healthy people, since attendees generally report better health and better health behaviors than nonattendees.^26,27 We felt this was more problematic for the large-scale urban event and that offering rural events and events in homeless housing improved the reach. Future efforts will involve the use of social media and mailings to solicit attendance. To improve follow-up, future work will include adding to the events: phlebotomy or expanded point-of-care testing; specialty care telehealth capability; cervical cancer screen self-collection; and tele-retinal services.

Conclusions

This program provided evidence that directed, preventive screening can be performed in outreach settings paired with vaccine events. These vaccination events in rural and homeless settings reached communities with demonstrable COVID-19 vaccination and other preventive care needs. This approach could be used to help veterans catch up on needed preventive care.

Acknowledgments

Veterans Affairs Pacific Islands Health Care System: Anthony Chance, LCSW; Nicholas Chang, PharmD; Andrew Dahlburg, LCSW; Wilminia G. Ellorimo-Gil, RN; Paul Guillory, RN; Wendy D. Joy; Arthur Minor, LCSW; Avalua Smith; Jessica Spurrier, RN. Veterans Health Administration Vet Center Program: Rolly O. Alvarado; Edmond G. DeGuzman; Richard T. Teel. Hawaii Institute for Human Services. U.S.VETS.

References

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