Curbside Consult with Dr. Jayne 9/27/21

Last week’s biggest medical news was the approval of COVID-19 booster shots for certain groups who had previously received the Pfizer immunization. When the announcement was made, one of the first things I thought about was how my clients would handle the need for outreach to populations who are now eligible. Certainly there would need to be some reporting to identify eligible patients, followed by communication, self-scheduling, and all the workflows we mastered earlier in the year. I wondered how long it would be before one of them reached out to me for assistance.

In the meantime, since I plan to be doing some in-person clinical work next month, I decided to schedule a booster dose for myself. Word on the street is that local pharmacies are throwing away doses due to lack of eligible patients, and if they’re going to waste a dose, it might as well go directly into the arm of a frontline physician.

I hopped online to see what my options were. The first place I looked was Costco, since I had a great experience there with my flu shot. Their website walks you through your vaccination history, but doesn’t ask anything about whether you are immunocompromised (which would have made you eligible for a third dose for several weeks) or your age. Instead, it gave me a happy green banner at the bottom of the screen that said, “Congratulations! You have received the recommended number of COVID-19 vaccine doses. You are officially vaccinated and do not need to schedule another appointment.”

The next place I checked was CVS. After a question about current symptoms and exposure status, I was asked whether I need to start the series, schedule a second dose, or whether I need to schedule a booster dose under the new criteria. Kudos to their IT team for updating the system quickly – things were looking promising. They also asked if I wanted to add a flu shot to the appointment (if available), so kudos for co-administration as a way of promoting public health. After keying in my date of last vaccine and that I had received the Pfizer product, it took me to a scheduling screen, where I quickly learned that there were no timely or convenient appointments at any of the three locations closest to my house. There were also no appointments available after 6 p.m. at the 10 closest locations. If we really want people to be vaccinated, we ought to make it convenient.

I also tried Walgreens, just for fairness if I was going to go the retail pharmacy route. Walgreens also had an updated system where I could quickly document my eligibility for a third dose or a booster dose depending on which criteria applied. Walgreens had an excellent assortment of evening appointments, but interestingly, none during the day – 5:45 p.m. was the earliest available slot. The site also offered the opportunity to add multiple other vaccines to the appointment including those for flu, shingles, pneumococcus, and Tdap. It was looking like the best option so far.

Glancing up at the vaccine card that’s stuck on the bulletin board behind my desk, I was reminded to think about the hospital where I received my initial COVID vaccines. There weren’t any opportunities to schedule vaccines of any kind within MyChart, only office visits, video visits, or telephone checkups. Visiting the health system’s website, it did appear that they were offering third dose appointments, but through a completely separate scheduling system depending on your state. After a few quick questions, it was on to the scheduling menu which had dozens of open slots but only on Mondays, Wednesdays, and Fridays, which might make it difficult for some patients depending on their work schedules. At the moment, my schedule is pretty flexible, so I scheduled for later this week. At the point where I needed to confirm the appointment that I selected, it offered me the opportunity to log into MyChart so that the appointment would be put on my record.

In hindsight, that seems like the best option regardless of convenience, because then all three doses will be from the same entity and I can download them all on a single record. Interestingly, the hospital in question hasn’t been very proactive about scheduling booster dose clinics for its employees and staff physicians, so it feels a little strange to be in the first wave of boosters when I’m not as exposed as others at the moment, especially considering how it was last December when the same health system was vaccinating its attorneys and marketing people but wouldn’t share doses with frontline urgent care physicians actively seeing dozens of COVID-positive patients each day. It just goes to illustrate how topsy-turvy and often without direction our healthcare system has become since this all started.

At a hospital where I have a pending application to be on the medical staff, they haven’t even started scheduling influenza vaccine clinics for employees despite typically starting them in September. Even though it’s not contraindicated to receive both vaccines on the same day, many people prefer not to receive two if they don’t absolutely have to. I’m hopeful that we have enough people masking and still modifying their activities that we have a flu season that is as mild as last year’s, but I’m not going to hold my breath.

I’ve got my talking points ready for any clients who reach out asking for assistance with scheduling of booster doses and have started putting some thoughts together on best practices for vaccine clinics in the event that the Pfizer vaccine is approved for children under age 12 next month. Parents in our community are clamoring for it as a way to avoid quarantines for their children as well as it being a way to try to restore some level of normalcy to childhood. I’m hoping that schools offer in-building vaccine clinics to make it easy for parents and caregivers, but given the politics around vaccines in some communities, that might be easier said than done.

How is your institution handling COVID-19 booster shots? Are you running recall campaigns, making a plan, or just trying to figure out how you’re going to address it? Leave a comment or email me.

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