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Eiden AL, Hartley L, Garbinsky D, Saande C, Russo J, Hufstader Gabriel M, Price M, Bhatti A. Adult vaccination coverage in the United States: A database analysis and literature review of improvement strategies. Hum Vaccin Immunother 2024; 20:2381283. [PMID: 39079694 PMCID: PMC11290753 DOI: 10.1080/21645515.2024.2381283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/19/2024] [Accepted: 07/14/2024] [Indexed: 08/02/2024] Open
Abstract
Despite vaccines being instrumental in reducing vaccine-preventable disease, adult vaccination rates in the United States (US) are below optimal levels. To better understand factors affecting vaccination rates, we analyzed trends in adult vaccination coverage using data from the Behavioral Risk Factor Surveillance System (BRFSS) and conducted a targeted literature review (TLR) on interventions to improve adult vaccination rates in the US. Both the BRFSS analysis and the TLR focused on influenza; pneumococcal disease; tetanus and diphtheria or tetanus, diphtheria, and acellular pertussis; herpes zoster; and human papillomavirus vaccination for US adults aged 18-64 years. The TLR additionally included hepatitis A and hepatitis B vaccination. Vaccination coverage rates (VCRs) and changes in VCRs were calculated using the 2011-2019 BRFSS survey data. For the TLR, the MEDLINE and MEDLINE In-Process databases were searched for articles on vaccination interventions published between January 2015 and June 2021. The BRFSS analysis showed that changes in VCRs were generally modest and positive for most states over the study period. The TLR included 32 articles that met the eligibility criteria; intervention strategies that improved adult vaccination outcomes incorporated an educational component, vaccination reminders or reinforcement at the point of care, or authorized non-clinician members of the healthcare team to vaccinate. Furthermore, interventions combining more than one approach appeared to enhance effectiveness. The strategies identified in this TLR will be valuable for policymakers and stakeholders to inform the development and implementation of evidence-based policies and practices to improve adult vaccination coverage.
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Affiliation(s)
| | | | - Diana Garbinsky
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Cassondra Saande
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Jon Russo
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | | | - Mark Price
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
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Zhang WX, Zhang Y, Du J, Shi W, Zhang SS, Yuan M, Zhou Y, Wang L, Zhao TS, Ma Q, Cai X, Zhang S, Yang H, Zhang X, Wang M, Huang N, Zeng J, Liu Y, Wu J, Cui F, Lu QB. Effectiveness of momentary intervention on influenza vaccination among the elderly in China: From willingness to action. Vaccine 2024; 42:125984. [PMID: 38777696 DOI: 10.1016/j.vaccine.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To evaluate the impact of momentary intervention on the willingness and actual uptake of influenza vaccination among the elderly in China. METHODS A cross-sectional study assessed the willingness of the elderly to receive influenza vaccination, and an momentary intervention aimed to increase vaccination willingness among those initially unwilling. The elderly reporting a willingness were offered free influenza vaccination through a community intervention program. RESULTS A total of 3138 participants were recruited in this study, and 61.3 % (95 % CI 59.6 %-63.0 %) were willing to receive influenza vaccination at baseline. The willingness rate of influenza vaccination increased to 79.8 % (95 % CI 78.4 %-81.2 %), with an increase of 18.5 % (95 % CI 16.3 %-20.7 %) after momentary intervention. The influenza vaccination rate was 40.4 % (95 % CI 38.5 %-42.3 %) before and 53.9 % (95 % CI 52.0 %-55.8 %) after momentary intervention with an increase of 13.5 % (95 % CI 10.9 %-16.2 %). There was no significant difference in influenza vaccination rates between the initially willing people and those who changed to be willing to receive influenza vaccination after momentary intervention (vaccination rates: 78.0 % vs. 81.3 %). CONCLUSION Momentary intervention has been shown to effectively enhance the willingness of the elderly to receive influenza vaccination, thereby facilitating the translation of this intention into actual behavior.
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Affiliation(s)
- Wan-Xue Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Yuanshan Zhang
- Department of Infectious Diseases Control, Lingcheng Center for Diseases Control and Prevention, Dezhou, China
| | - Juan Du
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Wanna Shi
- Department of Infectious Diseases Control, Lingcheng Center for Diseases Control and Prevention, Dezhou, China
| | - Shan-Shan Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | | | - Yiguo Zhou
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Lili Wang
- Department of Immunization Program, Lingcheng Center for Diseases Control and Prevention, Dezhou, China
| | - Tian-Shuo Zhao
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Qinyi Ma
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Xianming Cai
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Sihui Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Han Yang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Xiyu Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Mingting Wang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Ninghua Huang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Jing Zeng
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Yaqiong Liu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China
| | - Jian Wu
- Department of Infectious Diseases Control, Lingcheng Center for Diseases Control and Prevention, Dezhou, China.
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
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Johansen ND, Vaduganathan M, Bhatt AS, Modin D, Chatur S, Claggett BL, Janstrup KH, Larsen CS, Larsen L, Wiese L, Dalager-Pedersen M, Køber L, Solomon SD, Sivapalan P, Jensen JUS, Martel CJM, Krause TG, Biering-Sørensen T. Rationale and design of NUDGE-FLU-CHRONIC and NUDGE-FLU-2: Two nationwide randomized trials of electronic nudges to increase influenza vaccination among patients with chronic diseases and older adults during the 2023/2024 influenza season. Am Heart J 2024; 272:23-36. [PMID: 38460754 DOI: 10.1016/j.ahj.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Yearly influenza vaccination is strongly recommended for older adults and patients with chronic diseases including cardiovascular disease (CVD); however, vaccination rates remain suboptimal, particularly among younger patients. Electronic letters incorporating behavioral nudges are highly scalable public health interventions which can potentially increase vaccination, but further research is needed to determine the most effective strategies and to assess effectiveness across different populations. The purpose of NUDGE-FLU-CHRONIC and NUDGE-FLU-2 are to evaluate the effectiveness of electronic nudges delivered via the Danish governmental electronic letter system in increasing influenza vaccination among patients with chronic diseases and older adults, respectively. METHODS Both trials are designed as pragmatic randomized implementation trials enrolling all Danish citizens in their respective target groups and conducted during the 2023/2024 influenza season. NUDGE-FLU-CHRONIC enrolls patients aged 18-64 years with chronic diseases. NUDGE-FLU-2 builds upon the NUDGE-FLU trial conducted in 2022/2023 and aims to expand the evidence by testing both previously successful and new nudges among adults ≥65 years during a subsequent influenza season. Persons with exemptions from the electronic letter system are excluded from both trials. In both trials, participants are randomized in a 2.45:1:1:1:1:1:1 ratio to either receive no electronic letter (usual care) or to receive one of 6 different behaviorally informed electronic letters. NUDGE-FLU-CHRONIC has randomized 299,881 participants with intervention letters delivered on September 24, 2023, while NUDGE-FLU-2 has randomized 881,373 participants and delivered intervention letters on September 13, 2023. Follow-up is currently ongoing. In both trials, the primary endpoint is receipt of influenza vaccination on or before January 1, 2024, and the secondary endpoint is time to vaccination. Clinical outcomes including respiratory and cardiovascular hospitalizations, all-cause hospitalization, and mortality are included as prespecified exploratory endpoints. Prespecified individual-level pooled analyses will be conducted across NUDGE-FLU, NUDGE-FLU-CHRONIC, and NUDGE-FLU-2. DISCUSSION NUDGE-FLU-CHRONIC is the first nationwide randomized trial of electronic nudges to increase influenza vaccination conducted among 18-64-year-old high-risk patients with chronic diseases. NUDGE-FLU-2 will provide further evidence on the effectiveness of electronic nudges among older adults ≥65 years. Collectively, the NUDGE-FLU trials will provide an extensive evidence base for future public health communications. TRIAL REGISTRATION NUDGE-FLU-CHRONIC: Clinicaltrials.gov: NCT06030739, registered September 11, 2023, https://clinicaltrials.gov/study/NCT06030739. NUDGE-FLU-2: Clinicaltrials.gov: NCT06030726, registered September 11, 2023, https://clinicaltrials.gov/study/NCT06030726.
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Affiliation(s)
- Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA
| | - Ankeet S Bhatt
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA; Kaiser Permanente San Francisco Medical Center & Division of Research, San Francisco, CA; Stanford University School of Medicine, Palo Alto, CA
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Safia Chatur
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kira Hyldekær Janstrup
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Schade Larsen
- Department of Clinical Medicine - Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Lykke Larsen
- Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Michael Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Køber
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pradeesh Sivapalan
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Cyril Jean-Marie Martel
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tyra Grove Krause
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Steno Diabetes Center Copenhagen, Copenhagen, Denmark.
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4
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Szilagyi PG, Duru OK, Casillas A, Ong MK, Vangala S, Tseng CH, Albertin C, Humiston SG, Clark E, Ross MK, Evans SA, Sloyan M, Fox CR, Lerner C. Text vs Patient Portal Messaging to Improve Influenza Vaccination Coverage: A Health System-Wide Randomized Clinical Trial. JAMA Intern Med 2024; 184:519-527. [PMID: 38497955 PMCID: PMC10949147 DOI: 10.1001/jamainternmed.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/26/2023] [Indexed: 03/19/2024]
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.
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Affiliation(s)
- Peter G. Szilagyi
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - O. Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Alejandra Casillas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Michael K. Ong
- 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
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | | | - Emma Clark
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Mindy K. Ross
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Sharon A. Evans
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Michael Sloyan
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Craig R. Fox
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Anderson School of Management, University of California, Los Angeles
- Department of Psychology, University of California, Los Angeles
| | - Carlos Lerner
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
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Khandaker G, Chapman G, Khan A, Al Imam MH, Menzies R, Smoll N, Walker J, Kirk M, Wiley K. Evaluating Pilot Implementation of 'PenCS Flu Topbar' App in Medical Practices to Improve National Immunisation Program-Funded Seasonal Influenza Vaccination in Central Queensland, Australia. Influenza Other Respir Viruses 2024; 18:e13280. [PMID: 38623599 PMCID: PMC11019295 DOI: 10.1111/irv.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The 'PenCS Flu Topbar' app was deployed in Central Queensland (CQ), Australia, medical practices through a pilot programme in March 2021. METHODS We evaluated the app's user experience and examined whether the introduction of 'PenCS Flu Topbar' in medical practices could improve the coverage of NIP-funded influenza vaccinations. We conducted a mixed-method study including a qualitative analysis of in-depth interviews with key end-users and a quantitative analysis of influenza vaccine administrative data. RESULTS 'PenCS Flu Topbar' app users reported positive experiences identifying patients eligible for NIP-funded seasonal influenza vaccination. A total of 3606 NIP-funded influenza vaccinations was administered in the eight intervention practices, 14% higher than the eight control practices. NIP-funded vaccination coverage within practices was significantly higher in the intervention practices (31.2%) than in the control practices (27.3%) (absolute difference: 3.9%; 95% CI: 2.9%-5.0%; p < 0.001). The coverage was substantially higher in Aboriginal and Torres Strait Islander people aged more than 6 months, pregnant women and children aged 6 months to less than 5 years for the practices where the app was introduced when compared to control practices: incidence rate ratio (IRR) 2.4 (95% CI: 1.8-3.2), IRR 2.7 (95% CI: 1.8-4.2) and IRR 2.3 (1.8-2.9) times higher, respectively. CONCLUSIONS Our evaluation indicated that the 'PenCS Flu Topbar' app is useful for identifying the patients eligible for NIP-funded influenza vaccination and is likely to increase NIP-funded influenza vaccine coverage in the eligible populations. Future impact evaluation including a greater number of practices and a wider geographical area is essential.
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Affiliation(s)
- Gulam Khandaker
- Central Queensland Public Health UnitCentral Queensland Hospital and Health ServiceRockhamptonQueenslandAustralia
- Research DivisionCentral Queensland UniversityRockhamptonQueenslandAustralia
- Discipline of Child and Adolescent Health, Sydney Medical SchoolThe University of SydneyCamperdownNew South WalesAustralia
| | - Gwenda Chapman
- Herston Biofabrication InstituteMetro North HealthHerstonQueenslandAustralia
| | - Arifuzzaman Khan
- Wide Bay Public Health UnitHervey Bay Hospital and Health ServiceHervey BayQueenslandAustralia
- School of Public HealthThe University of QueenslandHerstonQueenslandAustralia
| | - Mahmudul Hassan Al Imam
- Central Queensland Public Health UnitCentral Queensland Hospital and Health ServiceRockhamptonQueenslandAustralia
- School of Health, Medical and Applied SciencesCentral Queensland UniversityRockhamptonQueenslandAustralia
| | - Robert Menzies
- Research DivisionSanofi PasteurCanterburyNew South WalesAustralia
| | - Nicolas Smoll
- Sunshine Coast Public Health UnitSunshine Coast Hospital and Health ServiceMaroochydoreQueenslandAustralia
| | - Jacina Walker
- Central Queensland Public Health UnitCentral Queensland Hospital and Health ServiceRockhamptonQueenslandAustralia
| | - Michael Kirk
- Rockhampton Business UnitCentral Queensland Hospital and Health ServiceRockhamptonQueenslandAustralia
| | - Kerrie Wiley
- Sydney School of Public HealthThe University of SydneyCamperdownNew South WalesAustralia
- Sydney Infectious Diseases InstituteThe University of SydneyCamperdownNew South WalesAustralia
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温 方, 杜 光, 田 丰, 赵 小. [Application and Effect of Patient Portal System in the Remote Management of Chronic Diseases for Older Adults With Coronary Heart Disease]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:418-424. [PMID: 38645871 PMCID: PMC11026880 DOI: 10.12182/20240360503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Indexed: 04/23/2024]
Abstract
Objective To investigate the application of personal health record (PHR) and chronic disease management platform established on the basis of patient portal system (PPS) in managing older adults with coronary heart disease and to examine the effect on patients' self-care ability, coping mode, and quality of life. Methods A total of 532 elderly patients with coronary heart disease were included in the study. All the participants enrolled were admitted to a tertiary-care hospital between January 2019 and June 2021. They were randomly assigned to the study group (269 cases) and the control group (263 cases). Patients in the control group were discharged with the routine discharge procedures and received the routine follow-up care. On the other hand, patients in the study group were discharged and followed up through the PHR and chronic disease management platform established on the basis of PPS. After 6 months, 12 months, and 18 months of patient management, the Exercise of Self-Care Agency (ESCA) Scale, Medical Coping Modes Questionnaire (MCMQ) and Seattle Angina Questionnaire (SAQ) were used to evaluate the patients' self-care ability, coping mode, and quality of life, respectively. The patient management effects of the two groups were analyzed. Results Before the management programs started, there was no statistically significant difference in the scores for the scales between the two groups of patients. After 6 months, 12 months, and 18 months of patient management, the ESCA scores of both groups were higher than those before patient management started (P<0.05). Facing scores in the MCMQ of both groups were higher than those before patient management started (P<0.05), while the scores for avoidance and yielding were lower than those before patient management started (P<0.05). The SAQ scores of both groups were higher than those before patient management started (P<0.05). After 6 months, 12 months and 18 months of patient management, the ESCA scores of the study group were always higher compared with those of the control group (P<0.05). The facing score of the study group was higher, while the scores for avoidance and yielding were lower compared with those of the control group (P<0.05). The SAQ scores of the study group were higher compared with those of the control group (P<0.05). The medication compliance rate in the study group (83.27%) was higher than that in the control group (69.96%) (P<0.05). The incidence of adverse cardiovascular events in the study group (4.09%) was lower than that in the control group (10.27%) (P<0.05). The average times of emergency treatment and readmission in the study group were lower compared with those of the control group (P<0.05). The patient satisfaction score of the study group was higher compared with that of the control group (P<0.05). Conclusion The PHR and chronic disease management platform established on the basis of PPS can increase the convenient access to medical care among elderly patients with coronary heart disease, which is conducive to improving their self-care ability, coping mode, and quality of life. In addition, the patient management effect is good.
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Affiliation(s)
- 方圆 温
- 四川省医学科学院·四川省人民医院 门诊部 (成都 610072)Outpatient Department, Sichuan Academic of Medical Science & Sichuan Province People's Hospital, Chengdu 610072, China
| | - 光会 杜
- 四川省医学科学院·四川省人民医院 门诊部 (成都 610072)Outpatient Department, Sichuan Academic of Medical Science & Sichuan Province People's Hospital, Chengdu 610072, China
| | - 丰 田
- 四川省医学科学院·四川省人民医院 门诊部 (成都 610072)Outpatient Department, Sichuan Academic of Medical Science & Sichuan Province People's Hospital, Chengdu 610072, China
| | - 小娟 赵
- 四川省医学科学院·四川省人民医院 门诊部 (成都 610072)Outpatient Department, Sichuan Academic of Medical Science & Sichuan Province People's Hospital, Chengdu 610072, China
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McLaughlin MM, Raitt MH, Tarasovsky G, Whooley MA, Dhruva SS. Informational Postcards Increase Engagement with Remote Monitoring Among Veterans with Pacemakers and Implantable Cardioverter-Defibrillators: a Stepped-Wedge Randomized Controlled Trial. J Gen Intern Med 2024; 39:87-96. [PMID: 38252247 PMCID: PMC10937872 DOI: 10.1007/s11606-023-08478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Remote monitoring (RM) of pacemakers and implantable cardioverter-defibrillators (ICDs) reduces morbidity and mortality. However, many patients are not adherent to RM. OBJECTIVE To test the effect of informational postcards on RM adherence. DESIGN/PATIENTS Stepped-wedge randomized controlled trial among Veterans with pacemakers and ICDs. INTERVENTION In wave 1, Veterans who had sent at least 1 transmission within the past 2 years but had become non-adherent were randomly assigned to receive a postcard or no postcard. Those receiving postcards were randomized to 1 of 2 messages: (1) a"warning" postcard describing risks of non-adherence or (2) an "encouraging" postcard describing benefits of adherence. In wave 2, Veterans who had either not received a postcard in wave 1 or had since become non-adherent were mailed a postcard (again, randomized to 1 of 2 messages). Patients who did not send an RM transmission within 1 month were mailed a second, identical postcard. MAIN MEASURES Transmission within 70 days. KEY RESULTS Overall, 6351 Veterans were included. In waves 1 and 2, postcards were mailed to 5657 Veterans (2821 "warning" messages and 2836 "encouraging" messages). Wave 1 included 2178 Veterans as controls (i.e., not mailed a postcard), some of whom received a postcard in wave 2 if they remained non-adherent. In wave 2, 3473 postcards were sent. Of the 5657 patients mailed a postcard, 2756 (48.7%) sent an RM transmission within 70 days, compared to 530 (24.3%) of 2178 controls (absolute difference 24.4%, 95% confidence interval [CI] 22.2%, 26.6%). Of those who sent a transmission, 71.8% did so after the first postcard. Transmission rates at 70 days did not significantly differ between "warning" and "encouraging" messages (odds ratio 1.04, 95% CI 0.92, 1.18). CONCLUSIONS Informational postcards led to a 24.4% absolute increase in adherence at 70 days among Veterans with pacemakers and ICDs who were non-adherent to RM.
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Affiliation(s)
- Megan M McLaughlin
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Merritt H Raitt
- Portland Veterans Affairs Health Care System, Portland, OR, USA
| | - Gary Tarasovsky
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Mary A Whooley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Sanket S Dhruva
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.
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8
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Kapoor A, Patel P, Chennupati S, Mbusa D, Sadiq H, Rampam S, Leung R, Miller M, Vargas KR, Fry P, Lowe MM, Catalano C, Harrison C, Catanzaro JN, Crawford S, Smith AM. Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study. JMIR Cardio 2024; 8:e49590. [PMID: 38265849 PMCID: PMC10851125 DOI: 10.2196/49590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/24/2023] [Accepted: 11/24/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The gap in anticoagulation use among patients with atrial fibrillation (AF) is a major public health threat. Inadequate patient education contributes to this gap. Patient portal-based messaging linked to educational materials may help bridge this gap, but the most effective messaging approach is unknown. OBJECTIVE This study aims to compare the responsiveness of patients with AF to an AF or anticoagulation educational message between 2 portal messaging approaches: sending messages targeted at patients with upcoming outpatient appointments 1 week before their scheduled appointment (targeted) versus sending messages to all eligible patients in 1 blast, regardless of appointment scheduling status (blast), at 2 different health systems: the University of Massachusetts Chan Medical School (UMass) and the University of Florida College of Medicine-Jacksonville (UFL). METHODS Using the 2 approaches, we sent patient portal messages to patients with AF and grouped patients by high-risk patients on anticoagulation (group 1), high-risk patients off anticoagulation (group 2), and low-risk patients who may become eligible for anticoagulation in the future (group 3). Risk was classified based on the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age between 65 and 74 years, and sex category (CHA2DS2-VASc) score. The messages contained a link to the Upbeat website of the Heart Rhythm Society, which displays print and video materials about AF and anticoagulation. We then tracked message opening, review of the website, anticoagulation use, and administered patient surveys across messaging approaches and sites using Epic Systems (Epic Systems Corporation) electronic health record data and Google website traffic analytics. We then conducted chi-square tests to compare potential differences in the proportion of patients opening messages and other evaluation metrics, adjusting for potential confounders. All statistical analyses were performed in SAS (version 9.4; SAS Institute). RESULTS We sent 1686 targeted messages and 1450 blast messages. Message opening was significantly higher with the targeted approach for patients on anticoagulation (723/1156, 62.5% vs 382/668, 57.2%; P=.005) and trended the same in patients off anticoagulation; subsequent website reviews did not differ by messaging approach. More patients off anticoagulation at baseline started anticoagulation with the targeted approach than the blast approach (adjusted percentage 9.3% vs 2.1%; P<.001). CONCLUSIONS Patients were more responsive in terms of message opening and subsequent anticoagulation initiation with the targeted approach.
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Affiliation(s)
- Alok Kapoor
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- University of Massachusetts Memorial Health Care, Worcester, MA, United States
| | - Parth Patel
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Soumya Chennupati
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Daniel Mbusa
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Hammad Sadiq
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Sanjeev Rampam
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Robert Leung
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- University of Massachusetts Memorial Health Care, Worcester, MA, United States
| | - Megan Miller
- College of Pharmacy, University of Florida, Jacksonville, FL, United States
| | | | - Patrick Fry
- College of Medicine, University of Florida, Jacksonville, FL, United States
| | | | - Christina Catalano
- College of Medicine, University of Florida, Jacksonville, FL, United States
| | - Charles Harrison
- College of Medicine, University of Florida, Jacksonville, FL, United States
| | | | - Sybil Crawford
- University of Massachusetts Chan Medical School, Worcester, MA, United States
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9
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Strasel M, VanLangen KM, Benzer J, Geyer A, Jameson AP, Dumkow LE. HPV vaccination rates in 9- and 10-year-olds following a pharmacist-led intervention. J Am Pharm Assoc (2003) 2024; 64:278-282. [PMID: 37604404 DOI: 10.1016/j.japh.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The American Cancer Society and the American Academy of Pediatrics recommend administering the human papillomavirus (HPV) vaccine to children aged 9 and 10 years to improve on-time vaccination rates as they continue to be below national goal. Pharmacist-led interventions using the electronic health record (EHR) may be an effective way to increase these rates. OBJECTIVE This study aimed to evaluate change in first-dose HPV vaccination rate in 9- and 10-year-olds before and after a multifaceted HPV outreach initiative. METHODS A pre-post, quasi-experimental study involving a pharmacist-led intervention was implemented at 2 primary care offices within a large health care network. Adolescents aged 9 and 10 years during the entire intervention period were included. Between November 1, 2021, and March 31, 2022, an education session was provided by an ambulatory care pharmacist to each primary care team regarding the HPV vaccine and eligibility of 9- and 10-year-olds. On June 1, 2022, a direct message was sent via the EHR to parents or guardians of eligible patients describing eligibility, risks and benefits, and best practice recommendations. The primary end point evaluated change in first-dose HPV vaccination rates in 9- and 10-year-olds measured 6 months after direct messaging. Secondary outcomes evaluated EHR message receipt, adverse events, and program revenue. Nominal outcomes were assessed with McNemar's test or Cochran's Q test using SPSS software; P < 0.05 was considered significant. RESULTS A total of 367 patients aged 9 and 10 years were eligible for HPV vaccination. After the intervention, 45 patients were vaccinated with vaccination rate increasing from 0.5% to 12.8% (P < 0.001). A total of 288 (78.5%) had access to EHR messaging with 203 (55.3%) having confirmed receipt of the message. No adverse reactions were reported within 7 days of vaccination. Most patients (76%) had private insurance, followed by Medicaid (22.6%) and uninsured (1.4%). Approximate revenue of the program was $4129.89. CONCLUSIONS A multifaceted intervention using education and EHR direct messaging significantly increased HPV vaccination rates in 9-and-10-year-olds.
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10
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Prieto-Campo Á, Batista AD, Magalhães Silva T, Herdeiro MT, Roque F, Figueiras A, Zapata-Cachafeiro M. Understanding vaccination hesitation among health professionals: a systematic review of qualitative studies. Public Health 2024; 226:17-26. [PMID: 37980837 DOI: 10.1016/j.puhe.2023.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES In terms of vaccination, people trust healthcare professionals (HCPs) more than any other source of information. They are the cornerstone of vaccination as they can move undecided populations not only towards vaccination but also towards non-vaccination. The aim of this systematic review was to explore the knowledge, beliefs, attitudes, and barriers associated with own vaccination and patient recommendation in HCPs. STUDY DESIGN This study incorporated a systematic review. METHODS A systematic review of studies published from January 1, 2000, to June 1, 2020, was conducted by searching PubMed and EMBASE electronic databases. Qualitative studies reporting outcomes related to knowledge, attitudes, or barriers related to vaccination/recommendation by healthcare personnel were included. The guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. RESULTS From a total of 2916 studies identified, 36 articles met the inclusion criteria. Some of the factors cited by the HCP that may contribute to vaccine hesitancy were (a) concerns regarding safety or efficacy of vaccines (23 articles); (b) time constraints (21 articles); (c) lack of knowledge about the vaccination/vaccine (19 articles); (d) costs (13 articles); (e) distrust of pharmaceutical industry (8 articles); and (f) considering oneself insusceptible (7 articles), stock shortage (7 articles), lack of personnel (5 articles), and feelings of unnecessary vaccination (5 articles). CONCLUSIONS Our review suggests that interventions to combat vaccine hesitancy should increase HCP education on vaccine efficacy and safety, as well as intervene on health system factors such as cost and time per visit. In this way, we could tackle the problem of vaccine hesitancy, which seriously threatens global public health.
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Affiliation(s)
- Á Prieto-Campo
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain
| | - A D Batista
- Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal
| | - T Magalhães Silva
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - M T Herdeiro
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - F Roque
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Avenida Dr. Francisco Sá Carneiro, no. ° 50, 6300-559, Guarda, Portugal; Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Av. Infante D. Henrique, 6200-506, Covilhã, Portugal; Escola Superior de Saúde, Instituto Politécnico da Guarda Rua da Cadeia, 6300-035, Guarda, Portugal.
| | - A Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - M Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
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11
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Eiden AL, Barratt J, Nyaku MK. A review of factors influencing vaccination policies and programs for older adults globally. Hum Vaccin Immunother 2023; 19:2157164. [PMID: 36656057 PMCID: PMC9980618 DOI: 10.1080/21645515.2022.2157164] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Policies and programs to increase vaccine coverage rates among adults 50 years of age or older are limited and vaccine uptake is often suboptimal. Our review evaluated evidence on the effectiveness and success of adult-targeted vaccination interventions and identified literature gaps. Literature was retrieved (2021) from PubMed, Embase, and Google Scholar databases. Outcomes assessed included data on an intervention's effectiveness and impact on vaccine uptake. Interventions were characterized thematically: affordability (n = 9), awareness (n = 25), and vaccination access (n = 6); and included influenza, pneumococcal, tetanus-containing, and herpes zoster vaccines. Interactive interventions directed toward patients, including provider-led educational initiatives and provider recommendations showed more positive associations than less interactive interventions, such as posters and reminder-recall letters. Provider interventions, including awareness campaigns, incentives, affordability efforts, or vaccination site expansion generally showed positive associations. Combining interventions was found to be successful across several studies. Barriers and interventions varied for population subgroups, therefore, tailoring programs is critical.
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Affiliation(s)
- Amanda L Eiden
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA
| | - Jane Barratt
- International Federation on Ageing, Toronto, ON, Canada
| | - Mawuli K Nyaku
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA
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12
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Leuchter RK, Ma S, Bell DS, Hays RD, Vidorreta FJS, Binder SL, Sarkisian CA. Embedding research study recruitment within the patient portal preCheck-in. J Am Med Inform Assoc 2023; 30:2028-2035. [PMID: 37595575 PMCID: PMC10654868 DOI: 10.1093/jamia/ocad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVE Patient portals are increasingly used to recruit patients in research studies, but communication response rates remain low without tactics such as financial incentives or manual outreach. We evaluated a new method of study enrollment by embedding a study information sheet and HIPAA authorization form (HAF) into the patient portal preCheck-in (where patients report basic information like allergies). MATERIALS AND METHODS Eligible patients who enrolled received an after-visit patient-reported outcomes survey through the patient portal. No additional recruitment/messaging efforts were made. RESULTS A total of 386 of 843 patients completed preCheck-in, 308 of whom signed the HAF and enrolled in the study (37% enrollment rate). Of 93 patients who were eligible to receive the after-visit survey, 45 completed it (48% completion rate). CONCLUSION Enrollment and survey completion rates were higher than what is typically seen with recruitment by patient portal messaging, suggesting that preCheck-in recruitment can enhance research study recruitment and warrants further investigation.
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Affiliation(s)
- Richard K Leuchter
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Suzette Ma
- UCLA Health Information Technology, UCLA Health, Los Angeles, CA 90095, United States
| | - Douglas S Bell
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- Clinical and Translational Science Institute, UCLA, Los Angeles, CA 90095, United States
| | - Ron D Hays
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA 90095, United States
| | | | - Sandra L Binder
- Clinical and Translational Science Institute, UCLA, Los Angeles, CA 90095, United States
| | - Catherine A Sarkisian
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center, Los Angeles, CA 90073, United States
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13
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Buja A, Grotto G, Taha M, Cocchio S, Baldo V. Use of Information and Communication Technology Strategies to Increase Vaccination Coverage in Older Adults: A Systematic Review. Vaccines (Basel) 2023; 11:1274. [PMID: 37515089 PMCID: PMC10384530 DOI: 10.3390/vaccines11071274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Coverage rates of routinely recommended vaccines in older adults still fall below the targets established by international and national advisory committees. As a result, related diseases still have a high incidence, morbidity, and mortality. Information and Communication Technologies (ICT) could provide useful tools to improve immunization rates by bringing information directly to the target user at a relatively low cost. The present research aims to systematically review recent literature on interventions applying ICT to improve the uptake of influenza, pneumococcal, COVID-19 and herpes zoster immunization rates among older adults. METHODS Studies published in English between 1 January 2000 and 10 November 2022 were identified by searching electronic medical databases (PubMed, Scopus) and were independently reviewed by two different authors. A total of 22 studies were included in this review. FINDINGS Interventions applied the following ICT tools: phone calls, text messages, messages sent via personal electronic medical records, automated phone calls, remote patient monitoring in a home telehealth program and emails. In terms of the vaccines promoted, 11 studies prompted the influenza vaccine, four prompted the influenza and pneumococcal vaccines, three the pneumococcal vaccine, two the herpes zoster vaccine, one the COVID-19 vaccine and one both the pneumococcal and herpes zoster vaccines. Overall, more than half of the studies (n = 12) found some level of effectiveness of these ICT strategies in increasing vaccination rates among older adults, while five studies were partially effective (for specific vaccines or population subgroups), and five reported no significant effect. CONCLUSIONS Prevention programs using ICT tools could be effective in promoting immunizations among older adults.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
| | - Giulia Grotto
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
| | - Mustapha Taha
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
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14
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Johansen ND, Vaduganathan M, Bhatt AS, Lee SG, Modin D, Claggett BL, Dueger EL, Samson S, Loiacono MM, Køber L, Solomon SD, Sivapalan P, Jensen JUS, Valentiner-Branth P, Krause TG, Biering-Sørensen T. Nationwide Utilization of Danish Government Electronic letter system for increasing inFLUenza vaccine uptake (NUDGE-FLU): Study protocol for a nationwide randomized implementation trial. Am Heart J 2023; 260:58-71. [PMID: 36801265 DOI: 10.1016/j.ahj.2023.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Annual influenza vaccination is widely recommended in older adults and other high-risk groups including patients with cardiovascular disease. The real-world effectiveness of influenza vaccination is limited by suboptimal uptake and effective strategies for increasing vaccination rates are therefore needed. The purpose of this trial is to investigate whether behavioral nudges digitally delivered via the Danish nationwide mandatory governmental electronic letter system can increase influenza vaccination uptake among older adults. METHODS The NUDGE-FLU trial is a randomized implementation trial randomizing all Danish citizens aged 65 years and above without an exemption from the Danish mandatory governmental electronic letter system to receive no digitally delivered behavioral nudge (usual care arm) or to receive one of 9 electronic letters (intervention arms) each leveraging different behavioral science strategies. The trial has randomized 964,870 participants with randomization clustered at the household level (n = 691,820 households). Intervention letters were delivered on September 16, 2022, and follow-up is currently ongoing. All trial data are captured using the nationwide Danish administrative health registries. The primary end point is the receipt of an influenza vaccine on or before January 1, 2023. The secondary end point is time to vaccination. Exploratory end points include clinical events such as hospitalization for influenza or pneumonia, cardiovascular events, all-cause hospitalization, and all-cause mortality. DISCUSSION The nationwide randomized NUDGE-FLU trial is one of the largest implementation trials ever conducted and will provide important insights into effective communication strategies to maximize vaccination uptake among high-risk groups. TRIAL REGISTRATION Clinicaltrials.gov: NCT05542004, registered September 15, 2022, https://clinicaltrials.gov/ct2/show/NCT05542004.
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Affiliation(s)
- Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA
| | - Ankeet S Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA; Kaiser Permanente Division of Research, Oakland, CA
| | - Simin Gharib Lee
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Lars Køber
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pradeesh Sivapalan
- Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Palle Valentiner-Branth
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tyra Grove Krause
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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15
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Szilagyi PG, Casillas A, Duru OK, Ong MK, Vangala S, Tseng CH, Albertin C, Humiston SG, Ross MK, Friedman SR, Evans S, Sloyan M, Bogard JE, Fox CR, Lerner C. Evaluation of behavioral economic strategies to raise influenza vaccination rates across a health system: Results from a randomized clinical trial. Prev Med 2023; 170:107474. [PMID: 36870572 PMCID: PMC11064058 DOI: 10.1016/j.ypmed.2023.107474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Influenza vaccination rates are low. Working with a large US health system, we evaluated three health system-wide interventions using the electronic health record's patient portal to improve influenza vaccination rates. We performed a two-arm RCT with a nested factorial design within the treatment arm, randomizing patients to usual-care control (no portal interventions) or to one or more portal interventions. We included all patients within this health system during the 2020-2021 influenza vaccination season, which overlapped with the COVID-19 pandemic. Through the patient portal, we simultaneously tested: pre-commitment messages (sent September 2020, asking patients to commit to a vaccination); monthly portal reminders (October - December 2020), direct appointment scheduling (patients could self-schedule influenza vaccination at multiple sites); and pre-appointment reminder messages (sent before scheduled primary care appointments, reminding patients about influenza vaccination). The main outcome measure was receipt of influenza vaccine (10/01/2020-03/31/2021). We randomized 213,773 patients (196,070 adults ≥18 years, 17,703 children). Influenza vaccination rates overall were low (39.0%). Vaccination rates for study arms did not differ: Control (38.9%), pre-commitment vs no pre-commitment (39.2%/38.9%), direct appointment scheduling yes/no (39.1%/39.1%), pre-appointment reminders yes/no (39.1%/39.1%); p > 0.017 for all comparisons (p value cut-off adjusted for multiple comparisons). After adjusting for age, gender, insurance, race, ethnicity, and prior influenza vaccination, none of the interventions increased vaccination rates. We conclude that patient portal interventions to remind patients to receive influenza vaccine during the COVID-19 pandemic did not raise influenza immunization rates. More intensive or tailored interventions are needed beyond portal innovations to increase influenza vaccination.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America.
| | - Alejandra Casillas
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America.
| | - O Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America.
| | - Michael K Ong
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America; VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, United States of America.
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America.
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America.
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America.
| | | | - Mindy K Ross
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America.
| | - Sarah R Friedman
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Sharon Evans
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, CA, United States of America.
| | - Michael Sloyan
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, CA, United States of America.
| | - Jonathan E Bogard
- Olin Business School Washington University in Saint Louis, United States of America.
| | - Craig R Fox
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, United States of America; Anderson School of Management, University of California at Los Angeles, CA, United States of America; Department of Psychology, University of California at Los Angeles, CA, United States of America.
| | - Carlos Lerner
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America.
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16
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Falah N, Terry A, Umer A, Kastner M, Oliverio KL, Matthews N, Kelly KM, Kellar-Guenther Y. A pilot study of home-based genetic testing completion rate in telegenetics cancer clinics in West Virginia Appalachia. Am J Med Genet A 2023; 191:1013-1019. [PMID: 36637370 DOI: 10.1002/ajmg.a.63109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 11/09/2022] [Accepted: 12/10/2022] [Indexed: 01/14/2023]
Abstract
Telegenetics has shifted some genetic testing performance to the patient's own home, with the patient collecting his/her own sample. Little is known regarding the rate of test completion of such home-based genetic testing. This study compared the completion rate of home-based genetic tests before and after a reminder system was implemented. In the pre-reminder group, we reviewed medical records for patients who were seen via telegenetics and agreed to complete genetic testing using an at-home test kit. In the reminder group, a prospective analysis of the genetic test completion rate was performed taking a clinical quality improvement approach where three reminders were provided for patients who had not submitted their at-home genetic testing. Our study included 94 patients' records: 46 pre-reminders and 48 reminders. The lab received 24 patient samples (52.2%) in the pre-reminder group. In the reminder group, 30 patients returned their kits (62.5%). Despite a higher percentage of patients completing their test in the reminder group, there was no statistically significant difference between the pre-reminder and reminder groups. The rate of test completion in our pilot test was statistically similar between the two groups, but the reminder group was trending toward a higher percent of completion which may be clinically meaningful.
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Affiliation(s)
- Nadia Falah
- Department of Pediatrics, Division of Genetics, West Virginia University Medicine Children's Hospital, Morgantown, West Virginia, USA.,West Virginia University Cancer Institute, Morgantown, West Virginia, USA
| | - Alissa Terry
- New York Mid-Atlantic Caribbean (NYMAC) Regional Genetics Network, Wadsworth Center, New York, USA
| | - Amna Umer
- Department of Pediatrics, West Virginia University Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA
| | - Marlee Kastner
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Kathryn L Oliverio
- West Virginia University Cancer Institute, Morgantown, West Virginia, USA
| | - Nicole Matthews
- Department of Pediatrics, Division of Genetics, West Virginia University Medicine Children's Hospital, Morgantown, West Virginia, USA
| | - Kimberly M Kelly
- West Virginia University Cancer Institute, Morgantown, West Virginia, USA.,School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
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17
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Stockwell M. Effect of a nationwide intervention of electronic letters with behavioural nudges on influenza vaccination in older adults in Denmark. Lancet 2023; 401:1058-1060. [PMID: 36889334 DOI: 10.1016/s0140-6736(23)00453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Melissa Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA; NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA.
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18
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Johansen ND, Vaduganathan M, Bhatt AS, Lee SG, Modin D, Claggett BL, Dueger EL, Samson SI, Loiacono MM, Køber L, Solomon SD, Sivapalan P, Jensen JUS, Martel CJM, Valentiner-Branth P, Krause TG, Biering-Sørensen T. Electronic nudges to increase influenza vaccination uptake in Denmark: a nationwide, pragmatic, registry-based, randomised implementation trial. Lancet 2023; 401:1103-1114. [PMID: 36889332 DOI: 10.1016/s0140-6736(23)00349-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Influenza vaccination rates remain suboptimal despite effectiveness in preventing influenza infection and related complications. We investigated whether behavioural nudges, delivered via a governmental electronic letter system, would increase influenza vaccination uptake among older adults in Denmark. METHODS We did a nationwide, pragmatic, registry-based, cluster-randomised implementation trial during the 2022-23 influenza season in Denmark. All Danish citizens aged 65 years or older or turning 65 years by Jan 15, 2023 were included. We excluded individuals living in nursing homes and individuals who had an exemption from the Danish mandatory governmental electronic letter system. Households were randomly assigned (9:1:1:1:1:1:1:1:1:1) to usual care or nine different electronic letters designed on the basis of different behavioural nudging concepts. Data were sourced from nationwide Danish administrative health registries. The primary endpoint was receipt of influenza vaccination on or before Jan 1, 2023. The primary analysis assessed an analytical set of one randomly selected individual per household, and a sensitivity analysis included all randomly assigned individuals and accounted for within-household correlation. The trial is registered with ClinicalTrials.gov, NCT05542004. FINDINGS We identified 1 232 938 individuals aged 65 years or older in Denmark and excluded 56 436 (4·6%) individuals living in nursing homes and 211 632 (17·2%) with an exemption from the electronic letter system. We randomly assigned 964 870 (78·3%) participants across 691 820 households. Compared with usual care, influenza vaccination rates were higher in the group receiving an electronic letter highlighting potential cardiovascular benefits of vaccination (81·00% vs 80·12%; difference 0·89 percentage points [99·55% CI 0·29-1·48]; p<0·0001) and the group receiving repeated letters at randomisation and at day 14 (80·85% vs 80·12%; difference 0·73 percentage points [0·13-1·34]; p=0·0006). These strategies improved vaccination rates across major subgroups including those with and without established cardiovascular disease. The cardiovascular gain-framed letter was particularly effective among participants who had not been vaccinated for influenza in the previous season (pinteraction=0·0002). A sensitivity analysis of all randomly assigned individuals accounting for within-household clustering yielded similar findings. INTERPRETATION Electronically delivered letters highlighting potential cardiovascular benefits of influenza vaccination or sent again as a reminder significantly increased vaccination uptake across Denmark. Although the magnitude of effectiveness was modest, the low-touch, inexpensive, and highly scalable nature of these electronic letters might be informative for future public health campaigns. FUNDING Sanofi.
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Affiliation(s)
- Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA, USA
| | - Ankeet S Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA, USA; Kaiser Permanente San Francisco Medical Center & Division of Research, San Francisco, CA, USA
| | - Simin Gharib Lee
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Lars Køber
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pradeesh Sivapalan
- Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Cyril Jean-Marie Martel
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Palle Valentiner-Branth
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tyra Grove Krause
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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19
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Real FJ, Zackoff MW, Rosen BL. Using Technology to Overcome Vaccine Hesitancy. Pediatr Clin North Am 2023; 70:297-308. [PMID: 36841597 DOI: 10.1016/j.pcl.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Technology holds great potential to address many vaccine hesitancy determinants and support vaccine uptake given its ability to amplify positive messages, support knowledge, and enhance providers' recommendations. Modalities previously implemented with variable success have included automated reminder systems, decision support for clinicians, online education programs, social media campaigns, and virtual reality curricula. Further research is needed to identify the optimal uses of technology at the patient/parent and provider levels to overcome vaccine hesitancy. The most effective interventions will likely be multipronged providing patients, parents, and providers with information related to vaccine status.
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Affiliation(s)
- Francis J Real
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, USA; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA.
| | - Matthew W Zackoff
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, USA; Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA
| | - Brittany L Rosen
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, USA; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA
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20
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Hashimoto S, Kitakata H, Kohsaka S, Fujisawa D, Shiraishi Y, Nakano N, Sekine O, Kishino Y, Katsumata Y, Yuasa S, Fukuda K, Kohno T. Confidence in self-care after heart failure hospitalization. J Cardiol 2023; 81:42-48. [PMID: 36241046 DOI: 10.1016/j.jjcc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Understanding patient perspectives of self-care is critical for improving multidisciplinary education programs and adherence to such programs. However, perspectives of self-care for patients with heart failure (HF) as well as the association between patient perspectives and patient-physician communication remain unclear. METHODS Confidence levels regarding self-care behaviors (eight lifestyle behaviors and four consulting behaviors) and self-monitoring were assessed using a self-administered questionnaire survey, which was directly distributed by dedicated physicians and nurses to consecutive patients hospitalized with HF in a tertiary-level hospital. Patient-physician communication was evaluated according to the quality of physician-provided information regarding "treatment and treatment choices" and "prognosis" using the Prognosis and Treatment Perception Questionnaire. Out of 202 patients, 187 (92.6 %) agreed to participate, and 176 completed the survey [valid response rate, 87.1 %; male, 67.0 %; median age, 73 (63-81) years]. Multivariate logistic regression analyses were conducted to predict low confidence in self-care (score in the lowest quartile). RESULTS High confidence (confident or completely confident >75 % of patients) was observed for all self-care behavior categories except low-salt diet (63.1 %), regular exercise (63.1 %), and flu vaccination (65.9 %). Lower confidence in self-care behavior was associated with low quality of patient-physician communication. With regard to self-monitoring, 62.5 % of patients were not confident in distinguishing worsening symptoms of HF from other diseases; non-confidence was also associated with low quality of patient-physician communication. CONCLUSIONS Hospitalized patients with HF had low confidence regarding regular exercise, salt restriction, and flu vaccination. The results also suggest patient-physician communication affects patient confidence.
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Affiliation(s)
- Shun Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Nakano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Otoya Sekine
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshikazu Kishino
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan.
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21
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Berset AE, Burkhardt MC, Xu Y, Mescher A, Brinkman WB. Effect of Electronic Outreach Using Patient Portal Messages on Well Child Care Visit Completion: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2242853. [PMID: 36399342 PMCID: PMC9675005 DOI: 10.1001/jamanetworkopen.2022.42853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Outreach messages to patients overdue for well child care (WCC) can be delivered different ways (ie, telephone calls and text messages). Use of electronic health record patient portals is increasingly common but their effectiveness is uncertain. OBJECTIVE To determine the effectiveness of patient portal outreach messages, with and without the date of the last WCC, on the scheduling and completion of WCC visits and completion of vaccinations. DESIGN, SETTING, AND PARTICIPANTS An intention-to-treat, multigroup, randomized clinical trial was conducted at 3 academic primary care practices from July 30 to October 4, 2021. The population included predominantly non-Hispanic Black, low-income children (age, 6-17 years) whose parent had an active portal account. INTERVENTIONS Participants were randomized to the standard message, tailored message, or no message (control) group. Two messages were delivered to those in the message groups. MAIN OUTCOMES AND MEASURES Outcomes included WCC visit scheduled within 2 weeks of the first intervention message, WCC visit completed within 8 weeks (primary outcome), and receipt of COVID-19 vaccine within 8 weeks. RESULTS Nine hundred forty-five patients participated (mean [SD] age, 9.9 [3.3] years, 493 [52.2%] girls, 590 [62.4%] non-Hispanic Black, 807 [85.4%] publicly insured). Scheduling rates were 18.4% in the standard message group (adjusted risk ratio [aRR], 1.97; 95% CI, 1.32-2.84) and 14.9% in the tailored message group (aRR, 1.57; 95% CI, 1.02-2.34) compared with the control group (9.5%). Well child care visit completion rates were 24.1% in the standard message group (aRR, 1.92; 95% CI, 1.38-2.60) and 19.4% in the tailored message group (aRR, 1.52; 95% CI, 1.06-2.13) compared with the control group (12.7%). Among eligible children, rates of receiving the COVID-19 vaccine were 16.7% in the standard message group compared with 4.8% in the tailored message (aRR, 3.41; 95% CI, 1.14-9.58) and 3.7% in the control groups (aRR, 4.84; 95% CI, 1.44-15.12). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, outreach messages delivered via electronic health record patient portals increased the rates of scheduling and completing WCC visits and receiving the COVID-19 vaccine, providing a useful tool to help restore WCC in populations whose care was delayed during the pandemic. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04994691.
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Affiliation(s)
- Anne E. Berset
- Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Mary Carol Burkhardt
- Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Yingying Xu
- Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Anne Mescher
- Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - William B. Brinkman
- Division of General & Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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22
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Halket D, Dang J, Phadke A, Jayasekera C, Kim WR, Kwo P, Downing L, Goel A. Targeted Electronic Patient Portal Messaging Increases Hepatitis C Virus Screening in Primary Care: a Randomized Study. J Gen Intern Med 2022; 37:3318-3324. [PMID: 35230622 PMCID: PMC9551157 DOI: 10.1007/s11606-022-07460-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/04/2022] [Indexed: 12/09/2022]
Abstract
IMPORTANCE Electronic health record (EHR) tools such as direct-to-patient messaging and automated lab orders are effective at improving uptake of preventive health measures. It is unknown if patient engagement in primary care impacts efficacy of such messaging. OBJECTIVE To determine whether more engaged patients, defined as those who have an upcoming visit scheduled, are more likely to respond to a direct-to-patient message with an automated lab order for hepatitis C virus (HCV) screening. DESIGN Randomized trial PARTICIPANTS: One thousand six hundred randomly selected Stanford Primary Care patients, 800 with an upcoming visit within 6 months and 800 without, born between 1945 and 1965 who were due for HCV screening. Each group was randomly divided into cohorts of 400 subjects each. Subjects were followed for 1 year. INTERVENTION One 400 subject cohort in each group received a direct-to-patient message through the EHR portal with HCV antibody lab order. MAIN OUTCOME AND MEASURE The EHR was queried on a monthly basis for 6 months after the intervention to monitor which subjects completed HCV screening. For any subjects screened positive for HCV, follow-up through the cascade of HCV care was monitored, and if needed, scheduled by the study team. KEY RESULTS Of 1600 subjects, 538 (34%) completed HCV screening. In the stratum without an upcoming appointment, 18% in the control group completed screening compared to 26% in intervention group (p<0.01). Similarly, in the stratum with an upcoming appointment, 34% in the control group completed screening compared to 58% in the intervention group (p<0.01). CONCLUSION Direct-to-patient messaging coupled with automated lab orders improved HCV screening rates compared to standard of care, particularly in more engaged patients. Including this intervention in primary care can maximize screening with each visit, which is particularly valuable in times when physical throughput in the healthcare system may be low.
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Affiliation(s)
- Douglas Halket
- Division of Primary Care and Population Health, Stanford University, Palo Alto, CA, USA.
| | - Jimmy Dang
- Population Health, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | - Anuradha Phadke
- Division of Primary Care and Population Health, Stanford University, Palo Alto, CA, USA
| | | | - W Ray Kim
- Division of Gastroenterology & Hepatology, Stanford University, Palo Alto, CA, USA
| | - Paul Kwo
- Division of Gastroenterology & Hepatology, Stanford University, Palo Alto, CA, USA
| | - Lance Downing
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Aparna Goel
- Division of Gastroenterology & Hepatology, Stanford University, Palo Alto, CA, USA
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23
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Nasiri MJ, Danaei B, Deravi N, Chirani AS, Bonjar AHS, Khoshgoftar Z, Karimi F. Impact of educational interventions on the prevention of influenza: A systematic review. Front Public Health 2022; 10:978456. [PMID: 36203669 PMCID: PMC9530567 DOI: 10.3389/fpubh.2022.978456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Seasonal influenza, a contagious viral disease affecting the upper respiratory tract, circulates annually, causing considerable morbidity and mortality. The present study investigates the effectiveness of educational interventions to prevent influenza. Methods We searched PubMed/Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) for relevant clinical studies up to March 1 2022. The following terms were used: "influenza," "flu," "respiratory infection," "prevent," "intervention," and "education." Results Out of 255 studies, 21 articles satisfied the inclusion criteria and were included in our study: 13 parallel randomized controlled trials (RCT) studies, two cross-over RCT studies, two cohort studies, and four quasi-experimental studies. A total of approximately 12,500 adults (18 years old or above) and 11,000 children were evaluated. Educational sessions and reminders were the most common interventions. The measured outcomes were vaccination rates, the incidence of respiratory tract infection (RTI), and preventive behaviors among participants. Eighteen out of 21 articles showed a significant association between educational interventions and the outcomes. Conclusions The included studies in the current systematic review reported the efficacy of health promotion educational interventions in improving knowledge about influenza, influenza prevention behaviors, vaccination rates, and decreased RTI incidence regardless of the type of intervention and the age of cases.
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Affiliation(s)
- Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Mohammad Javad Nasiri
| | - Bardia Danaei
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amir Hashem Shahidi Bonjar
- Clinician Scientist of Dental Materials and Restorative Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Khoshgoftar
- Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Zohreh Khoshgoftar
| | - Forouzan Karimi
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Forouzan Karimi
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24
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Fitzpatrick M, Sadiq H, Rampam S, Araia A, Miller M, Vargas KR, Fry P, Smith AM, Lowe MM, Catalano C, Harrison C, Catanzaro J, Crawford S, McManus D, Kapoor A. Preventing preventable strokes: A study protocol to push guideline-driven atrial fibrillation patient education via patient portal. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:241-246. [PMID: 36310680 PMCID: PMC9596318 DOI: 10.1016/j.cvdhj.2022.07.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The main approach to preventing stroke in patients with atrial fibrillation (AF) is anticoagulation (AC), but only about 60% of at-risk individuals are on AC. Patient-facing electronic health record–based interventions have produced mixed results. Little is known about the impact of health portal–based messaging on AC use. Objective The purpose of this study was describe a protocol we will use to measure the association between AC use and patient portal message opening. We also will measure patient attitudes toward education materials housed on a professional society Web site. Methods We will send portal messages to patients aged ≥18 years with AF 1 week before an office/teleconference visit with a primary care or cardiology provider. The message will be customized for 3 groups of patients: those on AC; those at elevated risk but off AC; and those not currently at risk but may be at risk in the future. Within the message, we will embed a link to UpBeat.org, a Web site of the Heart Rhythm Society containing patient educational materials. We also will embed a link to a survey. Among other things, the survey will request patients to rate their attitude toward the Heart Rhythm Society Web pages. To measure the effectiveness of the intervention, we will track AC use and its association with message opening, adjusting for potential confounders. Conclusion If we detect an increase in AC use correlates with message opening, we will be well positioned to conduct a future comparative effectiveness trial. If patients rate the UpBeat.org materials highly, patients from other institutions also may benefit from receiving these materials.
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Affiliation(s)
- Michael Fitzpatrick
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Medicine, University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Hammad Sadiq
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sanjeev Rampam
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Almaz Araia
- Department of Practice Improvement and Policy, Heart Rhythm Society, Washington, District of Columbia
| | - Megan Miller
- Department of Medicinal Chemistry, University of Florida College of Pharmacy, Jacksonville, Florida
| | - Kevin Rivera Vargas
- Department of Medicinal Chemistry, University of Florida College of Pharmacy, Jacksonville, Florida
| | - Patrick Fry
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Anne Marie Smith
- Department of Practice Improvement and Policy, Heart Rhythm Society, Washington, District of Columbia
| | | | - Christina Catalano
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Charles Harrison
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - John Catanzaro
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Sybil Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Medicine, University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Alok Kapoor
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Medicine, University of Massachusetts Memorial Health Care, Worcester, Massachusetts
- Address reprint requests and correspondence: Dr Alok Kapoor, Biotech One, Suite 100, University of Massachusetts Medical School, 365 Plantation St, Worcester, MA 01605.
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25
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Lieu TA, Elkin EP, Escobar PR, Finn L, Klein NP, Durojaiye C, Prausnitz S, Quesenberry CP, Sawyer D, Teran S, Goler N, Parodi SM, Chen YFI. Effect of Electronic and Mail Outreach From Primary Care Physicians for COVID-19 Vaccination of Black and Latino Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2217004. [PMID: 35713906 PMCID: PMC9206195 DOI: 10.1001/jamanetworkopen.2022.17004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE COVID-19 morbidity is highest in Black and Latino older adults. These racial and ethnic groups initially had lower vaccination uptake than others, and rates in Black adults continue to lag. OBJECTIVES To evaluate the effect of outreach via electronic secure messages and mailings from primary care physicians (PCPs) on COVID-19 vaccination uptake among Black and Latino older adults and to compare the effects of culturally tailored and standard PCP messages. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from March 29 to May 20, 2021, with follow-up surveys through July 31, 2021. Latino and Black individuals aged 65 years and older from 4 Kaiser Permanente Northern California (KPNC) service areas were included. Data were analyzed from May 27, 2021, to September 28, 2021. INTERVENTIONS Individuals who had not received COVID-19 vaccination after previous outreach were randomized to electronic secure message and/or mail outreach from their PCP, similar outreach with additional culturally tailored content, or usual care. Outreach groups were sent a secure message or letter in their PCP's name, followed by a postcard to those still unvaccinated after 4 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was time to receipt of COVID-19 vaccination during the 8 weeks after initial study outreach. KPNC data were supplemented with state data from external sources. Intervention effects were evaluated via proportional hazards regression. RESULTS Of 8287 included individuals (mean [SD] age, 72.6 [7.0] years; 4665 [56.3%] women), 2434 (29.4%) were Black, 3782 (45.6%) were Latino and preferred English-language communications, and 2071 (25.0%) were Latino and preferred Spanish-language communications; 2847 participants (34.4%) had a neighborhood deprivation index at the 75th percentile or higher. A total of 2767 participants were randomized to culturally tailored PCP outreach, 2747 participants were randomized to standard PCP outreach, and 2773 participants were randomized to usual care. Culturally tailored PCP outreach led to higher COVID-19 vaccination rates during follow-up compared with usual care (664 participants [24.0%] vs 603 participants [21.7%]; adjusted hazard ratio (aHR), 1.22; 95% CI, 1.09-1.37), as did standard PCP outreach (635 participants [23.1%]; aHR, 1.17; 95% CI, 1.04-1.31). Individuals who were Black (aHR, 1.19; 95% CI, 1.06-1.33), had high neighborhood deprivation (aHR, 1.17; 95% CI, 1.03-1.33), and had medium to high comorbidity scores (aHR, 1.19; 95% CI, 1.09-1.31) were more likely to be vaccinated during follow-up. CONCLUSIONS AND RELEVANCE This randomized clinical trial found that PCP outreach using electronic and mailed messages increased COVID-19 vaccination rates among Black and Latino older adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05096026.
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Affiliation(s)
- Tracy A. Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland
- The Permanente Medical Group, Oakland, California
| | - Eric P. Elkin
- Division of Research, Kaiser Permanente Northern California, Oakland
- TPMG Consulting Services, Oakland, California
| | | | - Lucy Finn
- TPMG Consulting Services, Oakland, California
| | - Nicola P. Klein
- Division of Research, Kaiser Permanente Northern California, Oakland
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Cimone Durojaiye
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | | | - Debora Sawyer
- The Permanente Medical Group, Oakland, California
- TPMG Consulting Services, Oakland, California
| | - Silvia Teran
- The Permanente Medical Group, Oakland, California
- TPMG Health Engagement Consulting Services, Oakland, California
| | - Nancy Goler
- The Permanente Medical Group, Oakland, California
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Włodarczyk D, Ziętalewicz U. Medics as a Positive Deviant in Influenza Vaccination: The Role of Vaccine Beliefs, Self-Efficacy and Contextual Variables. Vaccines (Basel) 2022; 10:vaccines10050723. [PMID: 35632479 PMCID: PMC9148145 DOI: 10.3390/vaccines10050723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
The influenza vaccination rate remains unsatisfactorily low, especially in the healthy adult population. The positive deviant approach was used to identify key psychosocial factors explaining the intention of influenza vaccination in medics and compare them with those in non-medics. Methods: There were 709 participants, as follows: 301 medics and 408 non-medics. We conducted a cross-sectional study in which a multi-module self-administered questionnaire examining vaccination beliefs, risk perception, outcome expectations (gains or losses), facilitators’ relevance, vaccination self-efficacy and vaccination intention was adopted. We also gathered information on access to vaccination, the strength of the vaccination habit and sociodemographic variables. Results: We used SEM and were able to explain 78% of the variance in intention in medics and 56% in non-medics. We identified both direct and indirect effects between the studied variables. In both groups, the intention was related to vaccination self-efficacy, stronger habits and previous season vaccination, but access to vaccines was significant only in non-medics. Conclusions: Applying the positive deviance approach and considering medics as positive deviants in vaccination performance extended the perspective on what factors to focus on in the non-medical population. Vaccination promotion shortly before the flu season should target non- or low-intenders and also intenders by the delivery of balanced information affecting key vaccination cognitions. General pro-vaccine beliefs, which may act as implicit attitudes, should be created in advance to build proper grounds for specific outcome expectations and facilitators’ recognition. It should not be limited only to risk perception. Some level of evidence-based critical beliefs about vaccination can be beneficial.
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Impact of Patient Portal Messaging Reminders with Self-Scheduling Option on Influenza Vaccination Rates: a Prospective, Randomized Trial. J Gen Intern Med 2022; 37:1394-1399. [PMID: 34131878 PMCID: PMC8205315 DOI: 10.1007/s11606-021-06941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patient portal messages have been used in a variety of ways to facilitate improved communication between provider and patient. These platforms have shown promise in many ways for improving various health outcomes and overall communication between patient and provider. OBJECTIVE Assess the impact of automated portal reminder messages and self-scheduling options on increasing rates of annual influenza vaccination. DESIGN This is a prospective, randomized, controlled study. PARTICIPANTS All patients who receive their primary care through an ambulatory primary care clinic at a large, multidisciplinary, academic health center. INTERVENTIONS One group of patients received a portal message reminder to undergo influenza vaccination. A second group received the same message with instructions to self-schedule the vaccination appointment. A third group received no portal message (control). MAIN MEASURES Rates of influenza vaccination in each group for previously unvaccinated patients in the 2019-2020 influenza season. KEY RESULTS For the group receiving the message with self-scheduling option (n=5408), the in-study vaccination rate was significantly greater than the group receiving no message (n=5621) (15.7% vs. 13.5%; p=0.002). For the group receiving a message alone (without self-scheduling) (n=5699), the in-study vaccination rate was significantly greater than the group receiving no message (15.1% vs. 13.5%; p=0.01). There was no significant difference in vaccination rate between the two intervention groups receiving messages (15.7% vs. 15.1%; p=0.549). CONCLUSIONS Portal messaging reminders increase annual influenza vaccination rates, but the addition of a self-scheduling option did not further increase rates. KEY WORDS vaccination patient portal messaging influenza.
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Szilagyi PG, Albertin CS, Casillas A, Valderrama R, Duru OK, Ong MK, Vangala S, Tseng CH, Humiston SG, Evans S, Sloyan M, Bogard JE, Fox CR, Lerner C. Effect of Personalized Messages Sent by a Health System's Patient Portal on Influenza Vaccination Rates: a Randomized Clinical Trial. J Gen Intern Med 2022; 37:615-623. [PMID: 34472020 PMCID: PMC8858355 DOI: 10.1007/s11606-021-07023-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
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).
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Affiliation(s)
- Peter G. Szilagyi
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA USA
| | - Christina S. Albertin
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA USA
| | - Alejandra Casillas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | - Rebecca Valderrama
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA USA
| | - O. Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | - Michael K Ong
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA USA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | | | - Sharon Evans
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, CA USA
| | - Michael Sloyan
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, CA USA
| | | | - Craig R. Fox
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA USA
- UCLA Anderson School of Management, Los Angeles, CA USA
- Department of Psychology, UCLA, Los Angeles, CA USA
| | - Carlos Lerner
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA USA
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Jenssen BP, Thayer J, Nekrasova E, Grundmeier RW, Fiks AG. Innovation in the pediatric electronic health record to realize a more effective platform. Curr Probl Pediatr Adolesc Health Care 2022; 52:101109. [PMID: 34895836 DOI: 10.1016/j.cppeds.2021.101109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Commercial electronic health records (EHRs) were first developed to automate business processes. As EHRs developed, design principles focused on transferring existing paper-based documentation to comparable electronic forms. In addition, a strong industry focus on adult healthcare settings and quality measures has limited attention and resources for high priority EHR functionality needed for the unique health care of children. The objective of this paper is to provide a review of innovation in the EHR, that includes a variety of established and emerging technologies that may help realize a more effective EHR in child health settings. A more effective EHR would serve as an electronic hub. Existing EHR infrastructure could provide the foundation upon which new technologies and approaches branch and extend, enabling more rapid and customizable innovation to better meet shifting stakeholder and end-user needs. Among many areas for improvement, key goals of innovation could include technology that relieves ambulatory primary care clinician documentation burden, identifies needs, and supports improved care coordination and outcomes, focused on the following key areas: identification of child and family care needs, decision support, documentation, care coordination, and family communication.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; The Possibilities Project, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia (CHOP), USA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
| | - Jeritt Thayer
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ekaterina Nekrasova
- The Possibilities Project, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia (CHOP), USA
| | - Robert W Grundmeier
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; The Possibilities Project, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia (CHOP), USA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; The Possibilities Project, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia (CHOP), USA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Murphy RP, Taaffe C, Ahern E, McMahon G, Muldoon O. A meta-analysis of influenza vaccination following correspondence: Considerations for COVID-19. Vaccine 2021; 39:7606-7624. [PMID: 34836661 PMCID: PMC8592234 DOI: 10.1016/j.vaccine.2021.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 11/20/2022]
Abstract
Background High vaccination rates are needed to protect against influenza and to end the COVID-19 pandemic. Health authorities need to know if supplementing mass communications with direct correspondence to the community would increase uptake. Objectives The primary objective is to determine if sending a single written message directly to individuals increases influenza vaccine uptake, and a secondary objective is to identify any identified content shown to increase influenza vaccine uptake. Methods MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, and PubMed were searched for RCTs testing a single correspondence for members of the community in OECD countries to obtain influenza vaccination. A meta-analysis with inverse-variance, random-effects modelling was used to estimate a mean, weighted risk ratio effect size measure of vaccine uptake. Studies were quality assessed and analysis was undertaken to account for potential publication bias. Results Twenty-eight randomized controlled trials were included, covering 45 interventions. Of the 45 interventions, 37 (82.2%) report an increase in influenza vaccination rates. A formal meta-analysis shows that sending a single written message increased influenza vaccine uptake by 16%, relative to the no contact comparator group (RR = 1.16, 95% CI [1.13-1.20], Z = 9.25, p < .001). Analysis shows that the intervention is effective across correspondence type, age group, time, and location, and after allowing for risk of publication bias. Limitations The generalizability of results across the OECD may be questioned. Conclusions and implications The implication for public health authorities organizing vaccination programs for influenza, and arguably also for COVID-19, is that sending written vaccination correspondence to members of the community is likely to increase uptake. Keywords: vaccine uptake, COVID-19, influenza, direct correspondence, meta-analysis. This study is pre-registered on osf.io; details can be found at https://osf.io/98mr7
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Affiliation(s)
- Robert P Murphy
- Stirling Management School, University of Stirling, Ireland; Department of Health, Ireland.
| | | | - Elayne Ahern
- School of Psychology, Dublin City University, Ireland
| | - Grace McMahon
- Department of Psychology, University of Limerick, Ireland
| | - Orla Muldoon
- Department of Psychology, University of Limerick, Ireland
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Papazoglou DD, Baretella O, Feller M, Del Giovane C, Moutzouri E, Aujesky D, Schwenkglenks M, O’Mahony D, Knol W, Dalleur O, Rodondi N, Baumgartner C. Cross-sectional study on the prevalence of influenza and pneumococcal vaccination and its association with health conditions and risk factors among hospitalized multimorbid older patients. PLoS One 2021; 16:e0260112. [PMID: 34784405 PMCID: PMC8594840 DOI: 10.1371/journal.pone.0260112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Older adults with chronic conditions are at high risk of complications from influenza and pneumococcal infections. Evidence about factors associated with influenza and pneumococcal vaccination among older multimorbid persons in Europe is limited. The aim of this study was to investigate the prevalence and determinants of these vaccinations in this population. METHODS Multimorbid patients aged ≥70 years with polypharmacy were enrolled in 4 European centers in Switzerland, Belgium, the Netherlands, and Ireland. Data on vaccinations, demographics, health care contacts, and comorbidities were obtained from self-report, general practitioners and medical records. The association of comorbidities or medical contacts with vaccination status was assessed using multivariable adjusted log-binomial regression models. RESULTS Among 1956 participants with available influenza vaccination data (median age 79 years, 45% women), 1314 (67%) received an influenza vaccination within the last year. Of 1400 patients with available pneumococcal vaccination data (median age 79 years, 46% women), prevalence of pneumococcal vaccination was 21% (n = 291). The prevalence of vaccination remained low in high-risk populations with chronic respiratory disease (34%) or diabetes (24%), but increased with an increasing number of outpatient medical contacts. Chronic respiratory disease was independently associated with the receipt of both influenza and pneumococcal vaccinations (prevalence ratio [PR] 1.09, 95% confidence interval [CI] 1.03-1.16; and PR 2.03, 95%CI 1.22-3.40, respectively), as was diabetes (PR 1.06, 95%CI 1.03-1.08; PR 1.24, 95%CI 1.16-1.34, respectively). An independent association was found between number of general practitioner visits and higher prevalence of pneumococcal vaccination (p for linear trend <0.001). CONCLUSION Uptake of influenza and particularly of pneumococcal vaccination in this population of European multimorbid older inpatients remains insufficient and is determined by comorbidities and number and type of health care contacts, especially outpatient medical visits. Hospitalization may be an opportunity to promote vaccination, particularly targeting patients with few outpatient physician contacts.
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Affiliation(s)
- Dimitrios David Papazoglou
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Oliver Baretella
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Denis O’Mahony
- Department of Medicine Cork, University College Cork National University of Ireland, Munster, IE, Ireland
- Department of Geriatric Medicine Cork, Cork University Hospital Group, Munster, IE, Ireland
| | - Wilma Knol
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Olivia Dalleur
- Louvain Drug Research Institute, and Pharmacy Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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Reñosa MDC, Landicho J, Wachinger J, Dalglish SL, Bärnighausen K, Bärnighausen T, McMahon SA. Nudging toward vaccination: a systematic review. BMJ Glob Health 2021; 6:bmjgh-2021-006237. [PMID: 34593513 PMCID: PMC8487203 DOI: 10.1136/bmjgh-2021-006237] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Vaccine hesitancy (VH) and the global decline of vaccine coverage are a major global health threat, and novel approaches for increasing vaccine confidence and uptake are urgently needed. ‘Nudging’, defined as altering the environmental context in which a decision is made or a certain behaviour is enacted, has shown promising results in several health promotion strategies. We present a comprehensive synthesis of evidence regarding the value and impact of nudges to address VH. Methods We conducted a systematic review to determine if nudging can mitigate VH and improve vaccine uptake. Our search strategy used Medical Subject Headings (MeSH) and non-MeSH terms to identify articles related to nudging and vaccination in nine research databases. 15 177 titles were extracted and assessed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final list of included articles was evaluated using the Mixed Methods Appraisal Tool and the Grading of Recommendations, Assessment, Development and Evaluations framework. Findings Identified interventions are presented according to a framework for behaviour change, MINDSPACE. Articles (n=48) from 10 primarily high-income countries were included in the review. Nudging-based interventions identified include using reminders and recall, changing the way information is framed and delivered to an intended audience, changing the messenger delivering information, invoking social norms and emotional affect (eg, through storytelling, dramatic narratives and graphical presentations), and offering incentives or changing defaults. The most promising evidence exists for nudges that offer incentives to parents and healthcare workers, that make information more salient or that use trusted messengers to deliver information. The effectiveness of nudging interventions and the direction of the effect varies substantially by context. Evidence for some approaches is mixed, highlighting a need for further research, including how successful interventions can be adapted across settings. Conclusion Nudging-based interventions show potential to increase vaccine confidence and uptake, but further evidence is needed for the development of clear recommendations. The ongoing COVID-19 pandemic increases the urgency of undertaking nudging-focused research. PROSPERO registration number CRD42020185817.
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Affiliation(s)
- Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Sarah L Dalglish
- Institute for Global Health, University College London, London, UK
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Lee JL, Foschini L, Kumar S, Juusola J, Liska J, Mercer M, Tai C, Buzzetti R, Clement M, Cos X, Ji L, Kanumilli N, Kerr D, Montanya E, Müller-Wieland D, Ostenson CG, Skolnik N, Woo V, Burlet N, Greenberg M, Samson SI. Digital intervention increases influenza vaccination rates for people with diabetes in a decentralized randomized trial. NPJ Digit Med 2021; 4:138. [PMID: 34535755 PMCID: PMC8448887 DOI: 10.1038/s41746-021-00508-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
People with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The intervention group received monthly messages through an online health platform. The control group received no intervention. Difference in self-reported vaccination rates was tested using multivariable logistic regression controlling for demographics and comorbidities. The study was registered at clinicaltrials.gov: NCT03870997. A total of 10,429 participants reported influenza vaccination status (5158 intervention, mean age (±SD) = 46.8 (11.1), 78.5% female; 5271 control, Mean age (±SD) = 46.7 (11.2), 79.4% female). After a 6-month intervention, 64.2% of the intervention arm reported influenza vaccination, vers us 61.1% in the control arm (diff = 3.1, RR = 1.05, 95% CI [1.02, 1.08], p = 0.0013, number needed to treat = 33 to obtain 1 additional vaccination). Completion of one or more intervention messages was associated with up to an 8% increase in vaccination rate (OR 1.27, 95% CI [1.17, 1.38], p < 0.0001). The intervention improved influenza vaccination rates in PWD, suggesting that leveraging new technology to deliver knowledge and information can improve influenza vaccination rates in high-risk populations to reduce public health burden of influenza. Rapid cycle innovation could maximize the effects of these digital interventions in the future with other populations and vaccines.
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Affiliation(s)
- J L Lee
- Evidation Health, San Mateo, CA, USA.,Emory University, Atlanta, GA, USA
| | | | - S Kumar
- Evidation Health, San Mateo, CA, USA
| | - J Juusola
- Evidation Health, San Mateo, CA, USA
| | | | - M Mercer
- Sanofi Pasteur, Swiftwater, PA, USA
| | - C Tai
- Evidation Health, San Mateo, CA, USA
| | - R Buzzetti
- Sapienza University of Rome, Rome, Italy
| | - M Clement
- University of British Columbia, Armstrong, British Columbia, Canada
| | - X Cos
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary and Hospital Innovation Department, Innovation Office at Institut Català de la Salut, Barcelona, Spain
| | - L Ji
- Peking University People's Hospital, Beijing, China
| | | | - D Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - E Montanya
- Hospital Universitari Bellvitge-IDIBELL, CIBERDEM and University of Barcelona, Barcelona, Spain
| | | | | | - N Skolnik
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - V Woo
- University of Manitoba, Winnipeg, Canada
| | - N Burlet
- Sanofi, Paris, France.,Kyowa Kirin International, Marlow, United Kingdom
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Smith R, Hubers J, Farraye FA, Sampene E, Hayney MS, Caldera F. Accuracy of Self-Reported Vaccination Status in a Cohort of Patients with Inflammatory Bowel Disease. Dig Dis Sci 2021; 66:2935-2941. [PMID: 32995995 PMCID: PMC7524037 DOI: 10.1007/s10620-020-06631-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Prevention of vaccine-preventable diseases is important in the care of patients with inflammatory bowel disease (IBD). Thus, accurate immunization histories are critical. Many providers rely on patient self-report when assessing immunization status. The primary aim of our study was to determine the accuracy of self-reported influenza vaccination status in a cohort of patients with IBD. METHODS We conducted a prospective study of patients with IBD who answered a vaccination status questionnaire and compared their responses to the Wisconsin Immunization Registry, a state-wide electronic immunization information system. The primary outcome was the sensitivity and specificity of self-reported influenza vaccination status. A secondary outcome evaluated the sensitivity and specificity of pneumococcal vaccination status. RESULTS A total of 200 patients with IBD were included in the study. Documented immunization rates were 74.5% for influenza vaccinations and 79.9% for pneumococcal vaccinations. Influenza vaccination self-report had a sensitivity of 98.7%, a specificity of 90.2%, a positive predictive value (PPV) of 96.7% and a negative predictive value (NPV) of 95.8%. In comparison, the sensitivity for pneumococcal vaccination was 83.5% with a specificity of 86.2%, PPV of 96.4%, and NPV of 54.3%. CONCLUSIONS Self-reported influenza immunization status is sensitive and specific in patients with IBD. Accuracy for pneumococcal vaccination is slightly lower, but responses were notable for a high PPV. Self-report is an effective way to determine influenza immunization status and provides useful information for receipt of pneumococcal vaccine in patients with IBD.
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Affiliation(s)
- Ryan Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jeffery Hubers
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Room 4240-01A MFCB, Madison, WI, 53705, USA
| | - Francis A Farraye
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Emmanuel Sampene
- Department of Biostatics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Mary S Hayney
- University of Wisconsin School of Pharmacy, Madison, WI, USA
| | - Freddy Caldera
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Room 4240-01A MFCB, Madison, WI, 53705, USA.
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35
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Lerner C, Albertin C, Casillas A, Duru OK, Ong MK, Vangala S, Humiston S, Evans S, Sloyan M, Fox CR, Bogard JE, Friedman S, Szilagyi PG. Patient Portal Reminders for Pediatric Influenza Vaccinations: A Randomized Clinical Trial. Pediatrics 2021; 148:peds.2020-048413. [PMID: 34321338 PMCID: PMC8669575 DOI: 10.1542/peds.2020-048413] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
- Carlos Lerner
- Department of Pediatrics and Mattel Children's Hospital
| | | | | | | | - Michael K. Ong
- Department of Medicine, David Geffen School of Medicine,Department of Health Policy and Management, Jonathan and Karin
Fielding School of Public Health,Department of Medicine, Veterans Affairs Greater Los Angeles
Healthcare System, Los Angeles, California
| | | | - Sharon Humiston
- Department of Medicine, David Geffen School of Medicine,Department of Pediatrics, Children’s Mercy, Kansas City,
Missouri
| | - Sharon Evans
- Information Services and Solutions, University of California, Los
Angeles, Health, Los Angeles, California
| | - Michael Sloyan
- Information Services and Solutions, University of California, Los
Angeles, Health, Los Angeles, California
| | - Craig R. Fox
- Department of Medicine, David Geffen School of Medicine,Anderson School of Management,Department of Psychology, College of Life Sciences, University of
California, Los Angeles, Los Angeles, California
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36
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Fiks AG, Nekrasova E, Hambidge SJ. Health Systems as a Catalyst for Immunization Delivery. Acad Pediatr 2021; 21:S40-S47. [PMID: 33958091 DOI: 10.1016/j.acap.2021.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania School and Children's Hospital of Philadelphia (AG Fiks), Philadelphia, Pa; Center for Pediatric Clinical Effectiveness (CPCE) and the Possibilities Project, Children's Hospital of Philadelphia (AG Fiks and E Nekrasova), Philadelphia, Pa.
| | - Ekaterina Nekrasova
- Center for Pediatric Clinical Effectiveness (CPCE) and the Possibilities Project, Children's Hospital of Philadelphia (AG Fiks and E Nekrasova), Philadelphia, Pa
| | - Simon J Hambidge
- Community Health Services, Denver Health (SJ Hambidge), Denver, Colo; Department of Pediatrics, University of Colorado School of Medicine (SJ Hambidge), Denver, Colo
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37
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Avdagovska M, Menon D, Stafinski T. Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review. J Med Internet Res 2020; 22:e24568. [PMID: 33289677 PMCID: PMC7755541 DOI: 10.2196/24568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 01/18/2023] Open
Abstract
Background Despite extensive and continuing research in the area of patient portals, measuring the impact of patient portals remains a convoluted process. Objective This study aims to explore what is known about patient portal evaluations and to provide recommendations for future endeavors. The focus is on mapping the measures used to assess the impact of patient portals on the dimensions of the Quadruple Aim (QA) framework and the Canada Health Infoway’s Benefits Evaluation (BE) framework. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) extension for scoping reviews. A systematic and comprehensive search was conducted using the Ovid platform, and the following databases were searched: Ovid MEDLINE (R) ALL (including epub ahead of print, in-process, and other nonindexed citations), EMBASE, and PsycINFO. CINAHL on the EBSCO platform and Web of Science were searched for studies published between March 2015 and June 2020. A systematic gray literature search was conducted using the Google search engine. Extracted data were tabulated based on a coding template developed to categorize the literature into themes and areas of interest. Results A total of 96 studies were included for data extraction. The studies were categorized based on the QA dimensions, with strict adherence to the definitions for each dimension. From the patients’ perspective, it was determined that most evaluations focused on benefits and barriers to access, access to test results, medication adherence, condition management, medical notes, and secure messaging. From the population perspective, the evaluations focused on the increase in population outreach, decrease in disparities related to access to care services, and improvement in quality of care. From the health care workforce perspective, the evaluations focused on the impact of patients accessing medical records, impact on workflow, impact of bidirectional secure messaging, and virtual care. From the health system perspective, the evaluations focused on decreases in no-show appointments, impact on office visits and telephone calls, impact on admission and readmission rates and emergency department visits, and impact on health care use. Overall, 77 peer-reviewed studies were mapped on the expanded version of the BE framework. The mapping was performed using subdimensions to create a more precise representation of the areas that are currently explored when studying patient portals. Most of the studies evaluated more than one subdimension. Conclusions The QA and BE frameworks provide guidance in identifying gaps in the current literature by providing a way to show how an impact was assessed. This study highlights the need to appropriately plan how the impact will be assessed and how the findings will be translated into effective adaptations.
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Affiliation(s)
- Melita Avdagovska
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Tania Stafinski
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Wijesundara JG, Ito Fukunaga M, Ogarek J, Barton B, Fisher L, Preusse P, Sundaresan D, Garber L, Mazor KM, Cutrona SL. Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial. J Med Internet Res 2020; 22:e16373. [PMID: 32975529 PMCID: PMC7547389 DOI: 10.2196/16373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/24/2020] [Accepted: 08/03/2020] [Indexed: 01/30/2023] Open
Abstract
Background Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. Objective The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. Methods Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record–documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. Results Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. Conclusions Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. Trial Registration ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277
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Affiliation(s)
- Jessica G Wijesundara
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mayuko Ito Fukunaga
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jessica Ogarek
- Center for Gerontology and Healthcare Research, Brown University, Providence, MA, United States
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Lloyd Fisher
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | | | | | - Lawrence Garber
- Meyers Primary Care Institute, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Health Services Research & Development, Center of Innovation, Edith Nourse Rogers Memorial Hospital, Veterans Health Administration, Bedford, MA, United States
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39
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Patient portal reminders have little impact on influenza vaccination rate. PHARMACOECONOMICS & OUTCOMES NEWS 2020; 854:27. [PMID: 32501386 PMCID: PMC7256343 DOI: 10.1007/s40274-020-6857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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