Patient Portal Reminders for Pediatric Influenza Vaccinations: A Randomized Clinical Trial

Abstract

Objectives: In a large health system, we evaluated the effectiveness of electronic health record patient portal reminders in increasing pediatric influenza vaccination rates.

Methods: We conducted an intention-to-treat randomized clinical trial of 22 046 children from 6 months to <18 years of age in 53 primary care practices. Patients (or parent and/or proxies) who were active portal users were randomly assigned to receive reminder messages framed as gains or losses or no messages. They were separately randomly assigned to receive a precommitment message before the influenza season. The primary outcome was receipt of ≥1 seasonal influenza vaccinations. Additionally, children 6 months to <3 years of age due for a second influenza vaccine were randomly assigned to receive a reminder or no reminder for the second vaccination.

Results: First-dose influenza vaccination rates were 56.9% in the control group, 58.0% in the loss-frame reminders group (P = .07), and 58.0% in the gain-frame group (P = .47). Rates were 58.3% in the precommitment group versus 57.0% in the control group (P = .11). Adjusted risk ratios for first vaccination were 1.02 (95% confidence interval [CI]: 1.00-1.04) for loss-frame reminders, 1.01 (95% CI: 0.98-1.05) for gain-frame reminders, and 1.02 (95% CI: 1.00-1.04) for precommitment messages versus controls. Second-dose vaccination rates were 44.1% in the control group and 55.0% in the reminder group, with an adjusted risk ratio of 1.25 (95% CI: 1.07-1.45).

Conclusions: Patient portal reminders for influenza vaccines in children, whether framed as gains or losses, did not increase first-dose influenza vaccination rates but were highly effective for the second dose of the vaccine.

Trial registration: ClinicalTrials.gov NCT04110314.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Humiston disclosed the following conflicts of interest: her employer receives grant money for work sponsored by the Pediatric Infectious Diseases Society Foundation, a not-for-profit organization. The Pediatric Infectious Diseases Society is funded for the project through unrestricted joint educational grants from Sanofi Pasteur US, Merck & Co., Inc., Pfizer, Inc., GlaxoSmithKline, and Seqirus USA, Inc. She is a consultant to Sanofi Pasteur, 2 universities with federally funded grants (University of Rochester and University of California, Los Angeles), and several not-for-profit organizations (the American Academy of Pediatrics and its chapters, Immunization Action Coalition, and Immunize Kansas Coalition); the other authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2021 by the American Academy of Pediatrics.

Figures

FIGURE 1

Consolidated Standards of Reporting Trials flow diagram. Patients were eligible for study participation if they were 6 months to