Effect of Personalized Messages Sent by a Health System's Patient Portal on Influenza Vaccination Rates: a Randomized Clinical Trial

Peter G Szilagyi, Christina S Albertin, Alejandra Casillas, Rebecca Valderrama, O Kenrik Duru, Michael K Ong, Sitaram Vangala, Chi-Hong Tseng, Sharon G Humiston, Sharon Evans, Michael Sloyan, Jonathan E Bogard, Craig R Fox, Carlos Lerner, Peter G Szilagyi, Christina S Albertin, Alejandra Casillas, Rebecca Valderrama, O Kenrik Duru, Michael K Ong, Sitaram Vangala, Chi-Hong Tseng, Sharon G Humiston, Sharon Evans, Michael Sloyan, Jonathan E Bogard, Craig R Fox, Carlos Lerner

Abstract

Background: Adult influenza vaccination rates are low. Tailored patient reminders might raise rates.

Objective: Evaluate impact of a health system's patient portal reminders: (1) tailored to patient characteristics and (2) incorporating behavioral science strategies, on influenza vaccination rates among adults.

Design: Pragmatic 6-arm randomized trial across a health system during the 2019-2020 influenza vaccination season. The setting was one large health system-53 adult primary care practices.

Participants: All adult patients who used the patient portal within 12 months, stratified by the following: young adults (18-64 years, without diabetes), older adults (≥65 years, without diabetes), and those with diabetes (≥18 years).

Interventions: Patients were randomized within strata to either (1) pre-commitment reminder alone (1 message, mid-October), (2) pre-commitment + loss frame messages, (3) pre-commitment + gain frame messages, (4) loss frame messages alone, (5) gain frame messages alone, or (6) standard of care control. Patients in the pre-commitment group were sent a message in mid-October, asking if they planned on getting an influenza vaccination. Patients in loss or gain frame groups were sent up to 3 portal reminders (late October, November, and December, if no documented influenza vaccination in the EHR) about importance and safety of influenza vaccine.

Main measures: Receipt of 1 influenza vaccine from 10/01/2019 to 03/31/2020.

Key results: 196,486 patients (145,166 young adults, 29,795 older adults, 21,525 adults with diabetes) were randomized. Influenza vaccination rates were as follows: for young adults 36.8%, for older adults 55.6%, and for diabetics 60.6%. On unadjusted and adjusted (for age, gender, insurance, race, ethnicity, and prior influenza vaccine history) analyses, influenza vaccination rates were not statistically different for any study group versus control.

Conclusions: Patient reminders sent by a health system's patient portal that were tailored to patient demographics (young adults, older adults, diabetes) and that incorporated two behavioral economic messaging strategies (pre-commitment and loss/gain framing) were not effective in raising influenza vaccination rates.

Trial registration: This trial was registered with ClinicalTrials.gov (NCT04110314).

Conflict of interest statement

Dr. Humiston is a consultant to Sanofi Pasteur. Dr. Humiston’s employer gets grant money for her work sponsored by the Pediatric Infectious Diseases Society Foundation, a not-for-profit organization. PIDS is funded for the project through unrestricted joint educational grants from Sanofi Pasteur US, Merck & Co., Inc., Pfizer, Inc., GlaxoSmithKline, and Seqirus USA, Inc.

All other authors have no conflicts of interest to report.

© 2021. The Author(s).

Figures

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Figure 1
Consort diagram

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Source: PubMed

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