Darielys Cordero, MPH, DrPh is the Special Programs Director at Puerto Rico Primary Healthcare Association (La Asociación de Salud Primaria de Puerto Rico) . In September 2020, Dr. Cordero joined the Office of Minority Health (OMH) for a virtual symposium highlighting state, tribal, territorial, and community-based efforts to address COVID-19 among racial and ethnic minority and American Indian and Alaska Native populations.
OMH is focused on the success, sustainability, and spread of health equity-promoting policies, programs, and practices. As part of its blog series, “Advancing the Response to COVID-19,” OMH followed up with Dr. Cordero to discuss how Puerto Rico’s community health centers have continued to evolve as the pandemic continues.
How has the Puerto Rico Primary Healthcare Association evolved throughout the pandemic to better meet the needs of your communities?
PRPCA has focused its efforts on supporting health centers' response in areas of health communication, education, and community outreach by keeping health care teams informed around COVID-19 vaccination, testing, and treatment. Lack of adherence to management of chronic conditions has been a crucial effect of lockdowns and local restrictions, so innovation and increasing access of services to those patients has been a top priority for the health centers.
The PRPCA is working with health centers to adapt their teams and operational infrastructure to provide self-monitoring equipment for the remote management of chronic conditions on their patients and to distribute medications to their homes. This required adaptation of the health care teams’ roles, education, and electronic medical records to align to this model of care.
The pandemic contributed to the previous burden and detriment of the health and social conditions experienced by the population in Puerto Rico from recent disasters. This represented a noteworthy opportunity for the PRPCA to work with community health centers’ understanding of the direct effects of those social risks on the health status of their patients, improving mechanisms to systematically identify those needs and strengthen and activate new partnerships to address primary risk factors of their specific populations. In summary, we aided in increasing collaborations with partners in health care systems to address those efforts, including support to the health center workforce in managing provider burnout and emotional health.
What role do Puerto Rico’s community health centers play during COVID-19 vaccine distribution?
The role of health centers in Puerto Rico distributing vaccines against COVID-19 has been essential to provide equitable access to communities across the island. This distribution has been carried out through key efforts as community mobilization, community health care work, and local engagement.
Health centers’ mobile units were used to drive vaccination directly to populations with more geographical limitations. Community health workers also provided orientation and vaccinations to patients in their homes, schools, or at work. Central to these efforts was also the development of collaborative alliances with churches, community leaders, and local governments to reach populations that have difficulty accessing health services.
Ninety-five percent of health centers are providers of COVID-19 vaccines and are accessible to the entire family, becoming family center vaccination sites, and contributing to Puerto Rico’s goal of being the first jurisdiction to achieve the highest vaccination rate. Health centers provide vaccine access to all groups of the population in the same facility, and patients can access other vaccines and preventive services. This resulted in mitigating access barriers to primary care during the pandemic.
Health centers in Puerto Rico are one of the largest networks of vaccine providers in the island and from the beginning of the pandemic have been key state partners in response and control strategies, including: surveillance, diagnostics, vaccination, and treatment, along with current efforts to be Test to Treat sites and Long-Term COVID-19 facilities in specific settings.
Many other states and territories in the U.S. have seen a rise in misinformation and distrust in healthcare systems. Have you seen a similar trend in Puerto Rico?
In Puerto Rico, there is also an increase in misinformation and distrust in health systems with the COVID-19 vaccine. During the pandemic, the need to communicate health information to patients in a simple and effective way has been highlighted, considering the capacity of each patient to process and understand the information. For this, health centers have incorporated various health education strategies for the communities they serve.
Health centers, community workers, and proactive health care educators and promoters work daily to combat the myths and lack of confidence in vaccines. This was provided through media, television, and campaigns on social platforms, in addition to on-site, one-to-one orientation. PRPCA supports these efforts by providing weekly newsletters with evidence-based and trustful resources to multidisciplinary staff for addressing patient concerns. Current collaborations with local and national organizations make possible the development of target initiatives to increase confidence in testing, vaccines, and treatment options for patients and workers.
As you noted in your presentation, many people in Puerto Rico don’t have experience with, or access to, technology such as cellphones. How does this impact public health communication strategies?
The demographic profile of the population and limited network connectivity in certain geographies of the island highlight access limitations to healthcare and preventive services. This constrains public health efforts to promote, prevent, and protect health care and vulnerable groups of the population that receive the highest impact. To continue delivering care because of the pandemic, innovations rapidly evolve as telemedicine, virtual education, and other technological enhancements. Considering the current island landscape, those innovations have limited effectiveness in population groups.
As a result, health centers focus their public health communication strategies on education, working with health promoters inside the community served (public places, churches, schools, drive through vaccination, etc.), and through home visits. Health centers increase access to health care, including outreach strategies to homeless, elderly, young, pregnant women, public housing residents, among others vulnerable groups. Using local radio media, telephone messages, in addition to social platforms, were part of the educational interventions. Other health centers renovate internal spaces to provide patients access to connection and telemedicine services.
What are some lessons you have learned during the pandemic that might help other community health centers and public health workers?
Some lessons learned during the pandemic have been:
- The importance of having community outreach workers as part of the health center workforce who are in the communities constantly, most of the time live in those communities, and know the profile and needs of the populations served by each health center. Health centers have the potential to adapt interventions to their target groups.
- Provide simple, population-targeted health education using evidence-based and reliable sources to the population that can foster informed decisions.
- Ongoing innovation in the development of strategies should consider the patient’s surrounding environment and the community from which they come. Also, multidisciplinary team-based care strategies provide a better whole-health, person-centered approach that can achieve equitable access to health that meets the needs of each patient.
Watch Dr. Cordero’s original virtual symposium presentation on OMH’s YouTube Channel.
Learn more about Cultural and Linguistic Competency and the National CLAS Standards.
Download and share the U.S Surgeon General’s COVID-19 Misinformation Campaign Toolkit.