As the supply of coronavirus vaccines ramps up, primary care clinics are getting ready to play a key role in vaccinating Americans.
The federal government partnered with large chain pharmacies, like CVS, Walgreens and Walmart, and networks of independent community pharmacies to increase access to the shots when they are widely available to the public.
But primary care clinicians say their strong relationships with patients will go a long way to ensure more people get a shot and return for a second dose.
"Primary care has really been at the front of this pandemic since day one," said Dr. Clive Fields, co-founder and chief medical officer at clinic operator VillageMD. "Ultimately when we look back on this, that will be the site for the vast majority of Americans to receive the vaccine."
The clinics' preparations echo how hospitals got ready in the months leading up to the first shipments of shots from Pfizer, which began arriving at sites across the country on Dec. 14. Moderna's vaccines began shipping about a week later.
An Oak Street Health location in Elgin, Illinois during its grand opening. Lydia Ramsey/Business Insider
Clinics are spending tens of thousands of dollars on freezers and refrigerators so they can store thousands of doses. They're figuring out which of their patients are most at risk for COVID-19 so they can administer shots to those patients first. And they're teaching staff and patients about the vaccines to allay any concerns they may have.
Planning has been tough, however, as some primary care clinics say they've been left out of the loop when it comes to states' plans for distributing the vaccines.
States have largely followed CDC recommendations to vaccinate healthcare workers and residents of nursing homes and other long-term care facilities first. In most states, the first vaccines went to big, centrally located hospitals.
But many clinics still have little idea of when they'll receive vaccines for their own healthcare workers, let alone their patients. They also don't know which vaccine they will be offered or how many doses.
It's particularly important to get the shots to clinic staff, because some research shows that primary care doctors are among those most at risk of dying from COVID-19.
Primary care chain ChenMed is preparing for multiple scenarios and outfitting some clinics with cold storage
With so much up in the air, Miami-based clinic chain ChenMed is preparing for any scenario, said Dr. Jason Lane, an infectious disease doctor who leads ChenMed's coronavirus task force.
"We're not getting a lot of information from the state health departments or pharmacies or hospitals at this point about when we're going to be engaged," Lane said.
ChenMed has more than 75 clinics in 10 states, and its patients are seniors, a group that's at high risk for COVID-19.
Read more: 'Our first glimmer of hope': Healthcare workers reflect on a devastating year and a brighter future as they get the first COVID-19 shots
ChenMed is working under the assumption that its staff and some patients would have an opportunity to be vaccinated outside of ChenMed centers before its clinics receive any doses. Clinical leaders in each market are reaching out to state health departments, health systems and pharmacies to ensure that ChenMed staff and patients get in line to be vaccinated at those places.
At the same time, ChenMed wants to be ready to accept vaccines at its own clinics.
The company spent more than $200,000 to equip one or two clinics in each of its markets with the cold storage needed to store the Moderna vaccine, which must be kept at a temperature of negative 20 degrees Celsius (negative 4 degrees Fahrenheit).
It decided against buying ultra-cold storage for Pfizer's vaccine. If ChenMed locations are offered that vaccine, Lane said the company will partner with other organization to ensure it uses all the doses before they spoil.
While it's waiting to receive vaccines, ChenMed is educating staff on how to talk to patients about the vaccines, in hopes of eliminating skepticism.
It surveyed staff to better understand how the workforce feels about the shots and will create an education campaign to respond to their concerns. It's also developing scripts that its clinicians can use to talk with patients about the vaccine.
"There's so much vaccine hesitancy out there that we're going to need to overcome to protect our patients that we're really going to need to play a very active role in teaching folks about the vaccine and making them feel comfortable," Lane said.
Read more: Pharmacies, doctor's offices and hospitals are gearing up to give coronavirus vaccines to millions of Americans. Here's how they're preparing and how much they stand to profit along the way. VillageMD is educating staff and patients on the safety of the vaccines to ensure more people get a shot
Likewise, VillageMD has focused most of its efforts on educating its patients on the safety of the vaccine, Fields said. The chain serves about 750,000 patients, including 200,000 in Houston. It recently partnered with Walgreens to open 500 to 700 more clinics.
Fields said primary care doctors will play an important role in dispelling skepticism and hesitancy related to the vaccine among the public.
Dr. Clive Fields, co-founder and chief medical officer of VillageMD VillageMD
"The best thing that we can do as primary care physicians is to use our trust as physicians to actually make sure patients make informed medical decisions informed by science, informed by physicians, informed by people who actually know what they're talking about, which sometimes through this pandemic has been in short supply," he said.
VillageMD will use its experience holding seasonal flu vaccination clinics to inform how it provides COVID-19 vaccines. The goal is to make it convenient for patients to get the vaccine by providing shots on weekends or during the evenings, Fields said.
The clinics have already stratified patients based on who is most likely get sick or die from COVID-19, so they can give the shots to patients at highest risk first.
VillageMD so far has received just under 1,000 doses of Moderna's shot and is currently vaccinating staff at two locations in Houston.
But the rollout hasn't been uniform across the country, and clinics in other states haven't yet received shots. The company has applied for additional clinics to administer vaccines and is hoping to receive more doses in the next two weeks, a company spokeswoman said.
"At this point, vaccine distribution is fluid and we're certainly hoping that there's a lot more clarity as we move into the new year," Fields said.
Oak Street spent more than $30,000 on ultra-cold freezers to store Pfizer vaccines and envisions vaccinating patients at clinics, drive-thrus and in their homes
Oak Street Health, a Chicago-based chain of primary care clinics that went public in August, spent more than $30,000 on two ultra-cold freezers that together can store about 181,000 Pfizer vaccine doses, the company told Business Insider.
The centers with those freezers will act as hubs and will distribute Pfizer vaccines on dry ice to other clinic locations. All Oak Street clinics, which care for 90,000 patients across 11 states, are equipped to store Moderna doses.
Oak Street hasn't yet received any vaccines to its clinics, but a spokeswoman said the company expects its first delivery within days. It will use those vaccines to give shots to clinic staff that haven't already gotten shots at affiliate hospitals.
It's still unclear when Oak Street will start vaccinating its patients. That will come after it has vaccinated all of its staff.
But Dr. Griffin Myers, Oak Street's chief medical officer, said the clinics have been working closely with public health officials in each of its markets and are ready to dole out shots.
"If we had a bunch of vaccine dropped on us, we would be able very effectively to get those to our patients and staff in the right order," Myers said.
Myers said Oak Street already has technology in place to determine which patients are at a higher risk for COVID-19 and should be vaccinated first, if there aren't enough shots to go around. Most of Oak Street's patients would fall into the high-risk category, however, as they are elderly patients who live in underserved areas.
Oak Street has been providing coronavirus testing at its centers and at drive-thru locations. Myers said he expects the company will also give COVID-19 shots in a variety of settings, from the centers to drive-thrus to patients' homes.
Because Oak Street's clinicians see their patients nine times per year on average, Myers said the clinics should have no problem getting patients back in for a second dose.
Primary care clinics have little insight into when they will receive vaccines for their own staff and patients.
Prominent for-profit chains like ChenMed, Oak Street and VillageMD have been able to use ties with state and local health departments and hospital systems to ensure their staff members are in line to get vaccinated, and some of their workers have already been able to get shots.
Still, some clinics have little idea when to expect vaccines inside their own clinics, and also don't know what to tell patients who are calling with questions about when they can expect to get a shot.
"In many states, the rollout plan is completely a mystery to frontline providers," said Dr. Emily Maxson, chief medical officer at Aledade, which helps independent primary care practices form accountable care organizations.
Many states have convened panels of experts to advise on vaccine distribution, and those panels often lack primary care doctors, Maxson said, adding that it's hard for those doctors to prepare when "they've been left out of the logistical planning."
A CDC committee has said that frontline essential workers, like emergency responders and teachers, along with people age 75 and older, should be next in line for the shots. But it's unclear who could be vaccinated after that, and it will likely vary by state.
Some states, including Florida and Texas, have deviated from those recommendations and started giving vaccines to people age 65 and over. Local health departments and health systems in those states are giving out shots.
But Maxson said it's imperative the vaccines eventually be administered at primary care practices.
"Primary care practices would be willing to work through whatever channels, but I think we do miss the opportunity with patients coming into the office everyday to vaccinate at site-of-service," she said. "Anytime you have to refer elsewhere, whether it's for a lab, a specialist referral, or a vaccine, you risk that drop off in adherence and patients not willing to take that extra step."
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