key: cord-0874088-xi53cc1p
authors: Guthrie, C.; Sadler, T.; Wadle, C.; Dohanich, E.; Couch, L.
title: 340: Challenges in obtaining COVID-19 vaccines: Bridging the gap for rural northeast Texas cystic fibrosis patients
date: 2021-11-30
journal: Journal of Cystic Fibrosis
DOI: 10.1016/s1569-1993(21)01764-1
sha: 9afe1348b7b5d27bfcec6a4196cbaba3615bab0f
doc_id: 874088
cord_uid: xi53cc1p

nan

Background: Rural residents face unique challenges in responding to the COVID-19 pandemic, often encountering barriers to health care that limit their ability to obtain the care they need, even when there is an adequate supply of health care services in the community. Cystic fibrosis (CF) patients at the University of Texas Health Science Center at Tyler (UTHSCT) have faced barriers to COVID-19 vaccination. UTHSCT serves the population of northeast Texas, a 35-county area with a population close to 1.5 million, more than half living in rural areas. In Texas, CF patients were included in Phase 1b of COVID vaccination, which included people aged 16 to 64 with underlying medical conditions that increase the risk of serious, lifethreatening complications from COVID-19. Because vaccine distribution was based on population, vaccine appointment slots filled quickly, resulting in delay of vaccination for our CF patients. Contributing factors included poor Internet access, lack of instruction on how to sign up for immunization, and lack of access to vaccine administration. Methods: The goal of this quality improvement initiative was to improve vaccine access and understand the barriers to COVID-19 vaccination of our CF patients. To better understand how many patients needed assistance, the CF team administered a survey to gather information on COVID-19 vaccination needs. After analyzing the survey results and starting to assist patients in signing up for the vaccine, the team encountered similar roadblocks as the patients: lack of vaccine availability and full vaccine signup lists. With hopes of getting patients vaccinated at a higher rate and within a reasonable amount of time, the CF director decided to reach out to hospital administration for assistance, because UTHSCT is a COVID-19 vaccine site. An email was written to the hospital administration requesting assistance with access to vaccinations for our CF patients. The administration agreed to place our patients on a high-risk cancellation list; if anyone with an appointment called to cancel their appointment, our CF patients would have access to those now open slots. Results: Surveys from 44 patients were analyzed. The survey response rate was 73%; 14 (32%) were male and 30 (68%) were female. Twenty (45%) requested assistance signing up for the COVID-19 vaccine, 8 (18%) had already received the vaccine, 3 (7%) requested to speak to their CF physician before deciding if they would sign up to receive vaccine, and 13 (30%) did not wish to receive the vaccine. Of the 20 patients who requested assistance with obtaining the COVID-19 vaccine, 17 (85%) were able to sign up for an appointment, whereas the clinic could not reach the other 3 patients for follow-up; 14 (82%) were able to receive their vaccine at UTHCT, and 3 (18%) were signed up for an appointment at a vaccination site closer to their homes.

Conclusion: This initiative demonstrated that patients with barriers to access to the vaccine were able to receive their vaccine or sign-up for an appointment. Our patients and families relayed positive feedback for the help they received. Our administration at UTHSC graciously assisted us in this process to expedite the vaccination process. This is yet another example where the CF team is needed to advocate for our CF population to aid with access to up-to-date health care trends.

Food insecurity screening at a pediatric cystic fibrosis center: Implementation, initial results, and future implications [1] . Prepandemic food insecurity rates among patients with cystic fibrosis (PwCF) were higher than in the general population [2, 3] . In response to the increased prevalence of food insecurity nationwide, telehealth food insecurity screening was initiated at the cystic fibrosis (CF) center at Children's Hospital of Orange County to identify patients and families experiencing food insecurity and to implement interventions to address food insecurity. Methods: The Food Insecurity Quality Improvement Quick Guide, developed by the CF Foundation Food Security Committee, was used to plan and implement food insecurity screening. A screening algorithm was created using validated questions from Hunger Vital Sign. Caregivers of PwCF or PwCF aged 18 and older were screened before their scheduled clinic visits as part of the previsit planning phone call by the medical assistant. If patients could not be screened during the previsit planning phone call, the case manager screened them at the beginning of the clinic visit. The 2 screening questions were prefaced with a script that introduced and normalized the annual screening process. Screening data and results were tracked and reviewed by the social worker and dietitian, who met with patient or family for further assessment and intervention. Gas cards, grocery cards, financial assistance, and community resource referrals were provided as appropriate. Results: Ninety-five percent of patients (n = 35) scheduled for CF clinic between 3/11/21 and 4/15/2021 were screened for food insecurity, 34 were screened via previsit planning phone call and 1 during the clinic visit. This screening algorithm allowed for 43% of the center patient population to be screened in a 5-week period. Three families (8.6%) screened positive for food insecurity, compared with the local county projected food insecurity rate of 10.7% for 2021 [1] . Of the 32 patients who screened negative for food insecurity, 6 (19%) had received financial assistance or resources in the form of gas cards, grocery cards, meal vouchers, or referrals during the preceding 12 months. Conclusion: These results suggest that food insecurity rates among PwCF at our center are slightly lower than in the general population in the county. We believe more patients are experiencing food insecurity or are at risk for food insecurity than currently identified through our screening process. More than one-quarter of the total center population received financial assistance last year from the CF social worker. More specifically, many families screened negative for food insecurity but experienced financial hardships in the past year and needed financial assistance. We suspect these families remain at high risk for food insecurity. While telehealth screening proved to be an efficient method of food insecurity screening, it is a preliminary screening tool and does not replace a more personalized assessment of psychosocial needs. Future efforts to identify sustainable financial and food insecurity resources should be prioritized to better meet the needs of CF the patient population.

State-by-state resource: The impact of coronavirus on food insecurity

The authors would like to thank the Cystic Fibrosis Foundation and the mentors from the Envision: Emerging Leaders in CF Endocrinology II Program.