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Publications

Journal Article Randomized Controlled Trial Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Ppublish 15 citations

PubMed: 38497955 DOI: 10.1001/jamainternmed.2024.0001

Text vs Patient Portal Messaging to Improve Influenza Vaccination Coverage: A Health System-Wide Randomized Clinical Trial.

JAMA Intern Med 184(5):519-527

Authors: Peter G Szilagyi, O Kenrik Duru, Alejandra Casillas, Michael K Ong, Sitaram Vangala, Chi-Hong Tseng, Christina Albertin, Sharon G Humiston, Emma Clark, Mindy K Ross, Sharon A Evans, Michael Sloyan, Craig R Fox, Carlos Lerner

Affiliations

  • Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles.
  • Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles.
  • VA Greater Los Angeles Healthcare System, Los Angeles, California.
  • Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles.
  • Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles.
  • Immunize.org, St Paul, Minnesota.
  • Department of Information Services and Solutions, UCLA Health System, Los Angeles, California.
  • Anderson School of Management, University of California, Los Angeles.
  • Department of Psychology, University of California, Los Angeles.

Abstract

Importance

Increasing influenza vaccination rates is a public health priority. One method recommended by the US Centers for Disease Control and Prevention and others is for health systems to send reminders nudging patients to be vaccinated.

Objective

To evaluate and compare the effect of electronic health record (EHR)-based patient portal reminders vs text message reminders on influenza vaccination rates across a health system.

Design, Setting, and Participants

This 3-arm randomized clinical trial was conducted from September 7, 2022, to April 30, 2023, among primary care patients within the University of California, Los Angeles (UCLA) health system.

Interventions

Arm 1 received standard of care. The health system sent monthly reminder messages to patients due for an influenza vaccine by portal (arm 2) or text (arm 3). Arm 2 had a 2 × 2 nested design, with fixed vs responsive monthly reminders and preappointment vs no preappointment reminders. Arm 3 had 1 × 2 design, with preappointment vs no preappointment reminders. Preappointment reminders for eligible patients were sent 24 and 48 hours before scheduled primary care visits. Fixed reminders (in October, November, and December) involved identical messages via portal or text. Responsive portal reminders involved a September message asking patients about their plans for vaccination, with a follow-up reminder if the response was affirmative but the patient was not yet vaccinated.

Main Outcomes and Measures

The primary outcome was influenza vaccination by April 30, 2023, obtained from the UCLA EHR, including vaccination from pharmacies and other sources.

Results

A total of 262 085 patients (mean [SD] age, 45.1 [20.7] years; 237 404 [90.6%] adults; 24 681 [9.4%] children; 149 349 [57.0%] women) in 79 primary care practices were included (87 257 in arm 1, 87 478 in arm 2, and 87 350 in arm 3). At the entire primary care population level, none of the interventions improved influenza vaccination rates. All groups had rates of approximately 47%. There was no statistical or clinically significant improvement following portal vs text, preappointment reminders vs no preappointment reminders (portal and text reminders combined), or responsive vs fixed monthly portal reminders.

Conclusions and Relevance

At the population level, neither portal nor text reminders for influenza vaccination were effective. Given that vaccine hesitancy may be a major reason for the lack of impact of portal or text reminders, more intensive interventions by health systems are needed to raise influenza vaccination coverage levels.

Trial Registration

ClinicalTrials.gov Identifier: NCT05525494.

MeSH

Vaccines, Internal Medicine, Patient Portals, Vaccination, Influenza, Human, Centers For Disease Control And Prevention, U.S., Vaccination Coverage

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