Patient views on reminder letters for influenza vaccinations in an older primary care patient population: a mixed methods study

Strategies for Improving Influenza Vaccination Rates in Patients with Chronic Renal Disease

BACKGROUND

The influenza vaccination rate among older and chronically ill patients in Germany has declined in the past decade in spite of vaccination campaigns.

METHODS

The influenza vaccination rate among persons with chronic renal disease was studied with the aid of billing data from various Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen, ASHIPs) in Germany. It was tested in a randomized controlled trial whether a written vaccination appeal, sent by physicians to patients, led to an increase in the vaccination rate. It was tested in a further such trial whether the vaccination rate among patients with renal disease could be improved by an appeal for vaccination that was sent by the ASHIPs to the treating nephrologists. Finally, it was also tested in a prospective interventional study whether the vaccination rate could be improved by an appeal for vaccination sent by a health- insurance carrier directly to the patients.

RESULTS

In 2012-2017, the vaccination rate among persons with chronically impaired renal function ranged from 41.1% to 46.9%; it ranged from 31.7% to 33.7% in kidney transplant recipients and from 42.7% to 44.7% in dialysis patients. An appeal for vaccination that was sent from physicians to patients raised the vaccination rate by 8.3% in the intervention group compared to the control group (p = 0.03; number needed to treat [NNT]: 13). On the other hand, an appeal for vaccination that was sent to the nephrologists lowered the vaccination rate by 0.8% in the intervention group compared to the control group. Finally, an appeal for vaccination that was sent by the health-insurance fund to the patients raised the vaccination rate by 3.2% (p<0.001; NNT: 32).

CONCLUSION

Fewer than half of all patients with chronic renal failure in Germany are vaccinated against influenza. The vaccination rate was found to be increased only after an appeal for vaccination that was sent directly to the patients. A letter sent to the treating physicians had no positive effect at all.

Receipt and effectiveness of influenza vaccination reminders for adults, 2011-2012 season, United States

BACKGROUND

Reminders for influenza vaccination improve influenza vaccination coverage. The purpose of this study was to describe the receipt of reminders for influenza vaccination during the 2011-12 influenza season among US adults.

METHODS

We analyzed data from the March 2012 National Flu Survey (NFS), a random digit dial telephone survey of adults in the United States. Relative to July 1, 2011, respondents were asked whether they received a reminder for influenza vaccination and the source and type of reminder they received. The association between reminder receipt and demographic variables, and the association between influenza vaccination coverage and receipt of reminders were also examined.

RESULTS

Of adults interviewed, 17.2% reported receiving a reminder since July 1, 2011. More than half (65.2%) of the reminders were sent by doctor offices. Hispanics and non-Hispanic blacks were more likely than non-Hispanic whites to report receiving a reminder. Adults who reported having a usual healthcare provider, health insurance, or a high-risk condition were more likely to report receiving reminders than the respective reference group. Adults reporting receipt of reminders were 1.15 times more likely (adjusted prevalence ratio, 95% CI: 1.06-1.25) to report being vaccinated for influenza than adults reporting not receiving reminders.

CONCLUSIONS

Differences exist in receipt of influenza vaccination reminders among adults. Reminders are important tools to improve adult influenza vaccination coverage. Greater use of reminders may lead to higher rates of adult influenza vaccination coverage and reductions in influenza-related morbidity.

Issuance of patient reminders for influenza vaccination by US-based primary care physicians during the first year of universal influenza vaccination recommendations

To estimate the number of physician-reported influenza vaccination reminders during the 2010-2011 influenza season, the first influenza season after universal vaccination recommendations for influenza were introduced, we interviewed 493 members of the Physicians Consulting Network. Patient vaccination reminders are a highly effective means of increasing influenza vaccination; nonetheless, only one quarter of the primary care physicians interviewed issued influenza vaccination reminders during the first year of universal vaccination recommendations, highlighting the need to improve office-based promotion of influenza vaccination.

Effects of Tooth Scaling Reminders for Dental Outpatients

We investigated the effect of sending reminders for patients to attend appointments for tooth scaling. A total of 389 outpatients were assigned to three intervention groups (reminders sent by postcard, mobile-phone text message or telephone call) and one control group. Reminders accompanied by short health education messages were sent to patients in each of the intervention groups. The outpatient revisiting behaviour of the patients was monitored. Patients who were reminded to come in for tooth scaling were 2.6 (95% CI 1.3–5.4) to 2.9 (CI 1.1 −7.8) times more likely to revisit compared to those who were not reminded. For every one point increase in the patient satisfaction score, patients were 3.8 (CI 1.2–11.6) times more likely to revisit. Patients with a high level of patient satisfaction and who had also received a reminder had the highest return rates (26%). Most patients (89–96%) had good feelings regarding the reminders; 65% of the patients agreed that reminders had enhanced their intention to revisit; 91 % of patients hoped to continue to receive reminders concerning broader dental health information. A reminder combined with health education is an effective way of improving preventative dental visiting behaviour.

Effect of provider and patient reminders, deployment of nurse practitioners, and financial incentives on cervical and breast cancer screening rates

OBJECTIVE

To evaluate the effect of the Provider and Patient Reminders in Ontario: Multi-Strategy Prevention Tools (P-PROMPT) reminder and recall system and pay-for-performance incentives on the delivery rates of cervical and breast cancer screening in primary care practices in Ontario, with or without deployment of nurse practitioners (NPs).

DESIGN

Before-and-after comparisons of the time-appropriate delivery rates of cervical and breast cancer screening using the automated and NP-augmented strategies of the P-PROMPT reminder and recall system.

SETTING

Southwestern Ontario.

PARTICIPANTS

A total of 232 physicians from 24 primary care network or family health network groups across 110 different sites eligible for pay-for-performance incentives.

INTERVENTIONS

The P-PROMPT project combined pay-for-performance incentives with provider and patient reminders and deployment of NPs to enhance the delivery of preventive care services.

MAIN OUTCOME MEASURES

The mean delivery rates at the practice level of time-appropriate mammograms and Papanicolaou tests completed within the previous 30 months.

RESULTS

Before-and-after comparisons of time-appropriate delivery rates (< 30 months) of cancer screening showed the rates of Pap tests and mammograms for eligible women significantly increased over a 1-year period by 6.3% (P < .001) and 5.3% (P < .001), respectively. The NP-augmented strategy achieved comparable rate increases to the automated strategy alone in the delivery rates of both services.

CONCLUSION

The use of provider and patient reminders and pay-for-performance incentives resulted in increases in the uptake of Pap tests and mammograms among eligible primary care patients over a 1-year period in family practices in Ontario.

A scoping literature review of collaboration between primary care and public health

AIM

The purpose of this scoping literature review was to determine what is known about: 1) structures and processes required to build successful collaborations between primary care (PC) and public health (PH); 2) outcomes of such collaborations; and 3) markers of their success.

BACKGROUND

Collaboration between PC and PH is believed to enable more effective individual and population services than what might be achieved by either alone.

METHODS

The study followed established methods for a scoping literature review and was guided by a framework that identifies systemic, organizational and interactional determinants for collaboration. The review was restricted to articles published between 1988 and 2008. Published quantitative and qualitative primary studies, evaluation research, systematic and other types of reviews, as well as descriptive accounts without an explicit research design, were included if they addressed either the structures or processes to build collaboration or the outcomes or markers of such collaboration, and were published in English.

FINDINGS

The combined search strategy yielded 6125 articles of which 114 were included. Systemic-level factors influencing collaboration included: government involvement, policy and fit with local needs; funding and resource factors, power and control issues; and education and training. Lack of a common agenda; knowledge and resource limitations; leadership, management and accountability issues; geographic proximity of partners; and shared protocols, tools and information sharing were influential at the organizational level. Interpersonal factors included having a shared purpose; philosophy and beliefs; clear roles and positive relationships; and effective communication and decision-making strategies. Reported benefits of collaboration included: improved chronic disease management; communicable disease control; and maternal child health. More research is needed to explore the conditions and contexts in which collaboration between PC and PH makes most sense and potential gains outweigh the associated risks and costs.

Pay-for-performance incentives for preventive care: views of family physicians before and after participation in a reminder and recall project (P-PROMPT)

OBJECTIVE

The Provider and Patient Reminders in Ontario: Multi-Strategy Prevention Tools (P-PROMPT) project was designed to increase the rates of delivery of 4 targeted preventive care services to eligible patients in primary care network and family health network practices eligible for pay-for-performance incentives.

DESIGN

Self-administered fax-back surveys completed before and after participation in the P-PROMPT project.

SETTING

Southwestern Ontario.

PARTICIPANTS

A total of 246 physicians from 24 primary care network or family health network practices across 110 different sites.

INTERVENTIONS

The P-PROMPT project provided several tools and services, including physician and patient reminders, office management tools, and administrative database integration.

MAIN OUTCOME MEASURES

Physicians' views about the delivery of preventive health services and pay-for-performance incentives before and after participation in the P-PROMPT project.

RESULTS

The preintervention survey was completed by 86.2% (212 of 246) of physicians and the postintervention survey was completed by 53.3% (131 of 246) of physicians; 46.7% (114 of 246) of the physicians completed both surveys. Overall, 80.5% of physicians indicated that the P-PROMPT project was useful (scores of 5 or higher on a 7-point Likert scale). Patient reminder letters (89.1%), physician approval lists of eligible patients (75.6%), administrative assistance with management fees (79.8%), and annual bonus calculations (75.2%) were rated as the most useful features of the program. Compared with the preintervention survey, there were statistically significant increases in the mean agreement scores that the established target levels and bonuses provided appropriate financial incentive to substantially increase the uptake of mammography (P=.012) and Papanicolaou tests (P=.003) but not to increase uptake of annual influenza vaccination or childhood immunizations. There were statistically significant changes in the mean ratings of relying on an opportunistic approach (P<.001), increased agreement about the effectiveness of the current approach to delivery of preventive care (P<.001), and increased use of preventive management fees to recall patients (P<.001).

CONCLUSION

The preventive care management program and P-PROMPT were viewed favourably by most respondents and were perceived to be useful in improving delivery of preventive health care services.

A qualitative evaluation of strategies to increase colorectal cancer screening uptake

OBJECTIVE

To obtain data that could be used to optimize the content and design of the targeted, mailed invitations that Ontario's provincewide colorectal cancer (CRC) screening program plans to use to increase screening uptake; to identify other strategies to increase CRC screening uptake; and to describe the effects of this qualitative work on a subsequent quantitative pilot study.

DESIGN

Qualitative study using semistructured focus groups.

SETTING

Four different Ontario communities.

PARTICIPANTS

Six focus groups comprising a total of 62 participants.

METHODS

Six focus groups were conducted in 4 different Ontario communities. For 3 of the communities, participants were recruited from the general population by a private marketing firm, using random-digit dialing, and received a small honorarium for participating. In Sault Ste Marie, participants were convenience samples recruited from a large primary care practice and were not offered compensation. Responses were elicited regarding various strategies for promoting CRC screening. Findings represent all responses observed as well as recommendations to program planners based on focus groups observations.

MAIN FINDINGS

Key themes identified included the importance of receiving a CRC screening invitation from one's family physician; a desire for personalized, brief communications; and a preference for succinct information in mailed materials. Strong support was indicated for direct mailing of the CRC screening kit (fecal occult blood test). Our findings substantially influenced the final design and content of the envelope and letter to be mailed in the subsequent quantitative pilot study.

CONCLUSION

We report strong support from our focus groups for a succinct, personalized invitation for CRC screening from one's own family physician. We have also shown that qualitative evaluation can be used to provide decision makers with pertinent and timely knowledge. Our study is highly relevant to other public health programs, particularly other Canadian jurisdictions planning organized CRC screening programs.

Women's views on reminder letters for screening mammography: Mixed methods study of women from 23 family health networks

OBJECTIVE

To explore women's perspectives on the acceptability and content of reminder letters for screening mammography from their family physicians, as well as such letters' effect on screening intentions.

DESIGN

Cross-sectional mailed survey followed by focus groups with a subgroup of respondents.

SETTING

Ontario.

PARTICIPANTS

One family physician was randomly selected from each of 23 family health networks and primary care networks participating in a demonstration project to increase the delivery of preventive services. From the practice roster of each physician, up to 35 randomly selected women aged 50 to 69 years who were due or overdue for screening mammograms and who had received reminder letters from their family physicians within the past 6 months were surveyed.

MAIN OUTCOME MEASURES

Recall of having received reminder letters and of their content, influence of the letters on decisions to have mammograms, and interest in receiving future reminder letters. Focus group interviews with survey respondents explored the survey findings in greater depth using a standardized interview guide.

RESULTS

The response rate to the survey was 55.7% (384 of 689), and 45.1% (173 of 384) of responding women reported having mammograms in the past 6 months. Among women who recalled receiving letters and either making appointments for or having mammograms, 74.8% (122 of 163) indicated that the letters substantially influenced their decisions. Most respondents (77.1% [296 of 384]) indicated that they would like to continue to receive reminders, and 28.9% (111 of 384) indicated that they would like to receive additional information about mammograms. Participants in 2 focus groups (n = 3 and n = 5) indicated that they thought letters reflected a positive attitude of physicians toward mammography screening. They also commented that newly eligible women had different information needs than women who had had mammograms done in the past.

CONCLUSION

Reminder letters were considered by participants to be useful and appeared to influence women's decisions to undergo mammography screening.