Potential COVID-19 vaccination opportunities in primary care practices in the United States

  1. Sanjay Basu
  2. Rebecca Weintraub
  3. Ishani Ganguli
  4. Russell Phillips
  5. Robert Phillips
  6. Asaf Bitton

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Abstract

Rapid, widespread COVID-19 vaccination is critical to pandemic mitigation and recovery. To help policymakers interested in further enhancing primary care delivery of COVID-19 vaccines, it is important to estimate the absolute number of vaccination opportunities, and identify how these opportunities may fall disproportionately among different communities given the unequal way that COVID-19 falls upon communities of color, low-income, and rural communities. To quantify the potential benefits of greater primary care engagement in vaccination efforts, we estimated the number of potential vaccination opportunities (PVOs) in primary care in the remaining calendar months of year 2021, and the possible uptake if we supplied enough vaccine to primary care practices to fulfill their opportunities. To estimate how many potential vaccination opportunities (PVOs) may occur in primary care, we used three sets of data, analyzing the latest available waves of the following: (i) the National Ambulatory Medical Care Survey (NAMCS, 2016, N = 677 providers); (ii) the National Health Interview Survey (NHIS, 2018, N = 29,839 individuals in 29,839 households); and (iii) the Medical Expenditure Panel Survey (MEPS, 2018, N = 40,025 individuals in 14,500 households). Per the NAMCS data, which provide a nationally-representative sample of ambulatory care visits, primary care physicians normally provide 40.2 million primary care visits per month. The majority of the primary care utilization is absorbed by those aged 16 to 64 years old who are not otherwise priority groups (i.e., not having chronic diseases as defined by ACIP) but the second large group of visits are those with a chronic disease (27.2% of all visits). As compared to the NAMCS data providing an estimate of care from the perspective of providers, the overall sample in NHIS provides a view of primary care access and utilization from a population perspective. Per NHIS, 34% of the civilian US population saw a generalist physician in the prior calendar year, or 109.8 million people. Overall, we would estimate that over the latter half of calendar year 2021, approximately 15 million potential vaccine opportunities per month would be available through US primary care practices.

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  1. Version published to 10.1101/2021.09.20.21263757v2 on medRxiv
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    SciScore for 10.1101/2021.09.20.21263757: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

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    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

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    The barriers to ensuring entry of primary care providers into the vaccine distribution pool should be further addressed, and include infrastructure and equipment limitations that may be mitigated through the availability of newer cold storage packages and the recent establishment of longer shelf-life for available vaccines,15–17 electronic registration and reporting infrastructure that may be more streamlined and accessible to providers,18,19 and--perhaps most of all--the inclusion of primary care representatives on state and local vaccine distribution committees and coordination agencies.20 The international experience of vaccine distribution has highlighted that several other nations, particularly those in the UK, Europe, and East Asia, have made use of distribution through primary care practices as a backbone for accelerating vaccination towards herd immunity levels.21 There are important limitations to the data and conclusions we derive here. First, the datasets are each limited in different ways, but all are limited to the civilian US population, and therefore do not account for important institutionalized populations who may be at particularly high risk for COVID-19 infection. Dedicated surveys of vaccination capacity, distribution, and gaps in care are ongoing for incarcerated and nursing home populations who have experienced particularly high risk.22,23 Second, the data are dated and historical, and therefore do not capture the recent shift towards utilization of tele...

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    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.09.20.21263757v1 on medRxiv