O2179: Evaluation of an Urgent Care-based Routine Immunization Program During the COVID-19 Pandemic

Background: Pediatric urgent care (PUC) centers may bolster immunization campaigns by offering vaccination during acute care visits. Few such programs have been described.

Methods: The Zuckerberg San Francisco General Hospital Children’s Health Center (CHC) provides primary, specialty, and acute care services to an urban, under-served community. CHC’s PUC began offering routine immunizations to San Francisco Health Network (SFHN) patients in July 2020, and began monitoring performance in March 2021. The intervention bundle was finalized with a dedicated nurse vaccinator in October 2022. The fraction of eligible patients receiving all recommended non-influenza/non-COVID immunizations was measured from March 1, 2021 – February 28, 2023 (primary measure). The fraction of eligible patients lost to primary care follow-up in the year following their urgent care visit was measured from March 1, 2021 – February 28, 2022 (balancing measure). Separate logistic regression models were fitted to identify predictors of immunization and loss to follow-up. The fraction of SFHN vaccine doses administered in PUC was measured during the final intervention period from October 31, 2022 – February 28, 2023 (impact measure).

Results: Of the 20,400 patients that presented to PUC, 1753 (8.59%) were eligible for vaccination. Of those eligible, 680 (38.79%) received all recommended immunizations. Patients under age 4 (OR 1.40, 95% CI 1.13-1.74), patients receiving primary care through the CHC (1.64, 1.24-2.16), and patients seen during the final intervention period (4.90, 3.80-6.31) were more likely, and patients seen by a senior pediatrics resident (0.65, 0.50-0.84) were less likely, to receive all recommended immunizations. No difference in vaccine administration was observed by sex, preferred language, or self-reported race. Patients receiving primary care through the CHC (1.83, 1.17 – 2.85) were more likely, and patients under age 4 (0.11, 0.07-0.18) were less likely, to be lost to follow-up after their PUC visit. No difference in follow-up was observed by sex, preferred language, self-reported race, or vaccine administration during the PUC visit. Of the patients receiving all recommended immunizations, 30.22% were lost to follow-up in the year following the visit. During the final intervention period, PUC administered 6.92% of all SFHN childhood vaccine doses and 9.82% of all adolescent vaccine doses.

Conclusion: Although most opportunities to vaccinate were missed, the introduction of routine immunization services in our PUC made a meaningful contribution to community vaccination with no effect on subsequent primary care follow-up during the COVID-19 pandemic. A large fraction of vaccinated patients was lost to follow-up in the year following the PUC visit, suggesting that PUC-based immunization programs may bolster community vaccination in settings confronting high rates of patient attrition. Additional research is needed to determine the generalizability of our findings to similar PUCs.