(PO-039) (PO-039) Expanding the role of psychiatrists to increase COVID-19 vaccination rates in clozapine-treated patients with serious mental illness: A quality improvement project

Background

A diagnosis of schizophrenia is the second largest predictor of mortality from COVID-19, after age (Nemani, 2021). Clozapine-treated patients may be particularly vulnerable since clozapine causes metabolic side effects that are associated with increased mortality from COVID-19. While COVID-19 vaccines represent the most effective preventive measure, patients with serious mental illness (SMI) have low vaccination rates in general compared to their peers without SMI (Lorenz, 2013). Psychiatric providers, who are experts in behavioral management, are in frequent contact with their patients, hence uniquely positioned to help shape patients’ vaccine attitudes and address barriers to vaccination.

Methods

A quality improvement project was designed to help psychiatric providers identify vaccine-hesitant patients, build vaccine confidence, and support COVID-19 vaccinations in a cohort of 193 clozapine-treated patients with SMI in a community mental health center. In-service education was provided to enhance clinicians’ vaccine knowledge and to apply their expertise in nudging and motivational interviewing to resolve patients’ vaccine ambivalence (McClure, 2017). At each visit starting in February 2021, clinicians conducted guided interview using a population-based management tool created based on literature and embedded in the electronic medical record to track patients’ vaccination intention, hesitancy, and uptake. 

Results

The actual vaccination rate in our clozapine cohort by the end of June 2021 was 84.5% compared to the MA state rate on the same date estimated to be between 62.5% and 77.3%. The increased vaccination rate was seen across all age groups. The content of vaccine hesitancy in this cohort prior to wide-spread vaccine availability and the practical barriers to completing vaccination series were qualitatively described. 

Discussion

By standardizing a process of vaccination support at outpatient psychiatric visits, psychiatric providers may positively impact vaccination rates among patients with SMI. Patients with SMI may face many barriers to vaccination and could benefit from psychiatric provider making sure they get fully vaccinated. 

Conclusion/Implications

Psychiatric patients, particularly those who are marginalized, have much to gain if psychiatric providers are involved in preventive health care such as the annual flu vaccine and hepatitis B (Freudenreich, 2021).

References:

Nemani K, Li C, Olfson M, et al. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry. 2021;78(4):380-386

Lorenz RA, Norris MM, Norton LC, Westrick SC. Factors associated with influenza vaccination decisions among patients with mental illness. Int J Psychiatry Med. 2013;46(1):1-13

McClure CC, Cataldi JR, O’Leary ST. Vaccine hesitancy: where we are and where we are going. Clinical therapeutics. 2017 Aug 1;39(8):1550-62.

Freudenreich O, Van Alphen MU, Lim C. The ABCs of successful vaccinations: A role for psychiatry. Current Psychiatry. 2021 Mar;20(3):48-9.