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Rodriguez RM, Eucker SA, Rafique Z, Nichol G, Molina MF, Kean E, O'Laughlin KN, Bezek SK, Goicochea K, Ford JS, Morse D, White J, Arreguin MI, Shughart L, Chavez CL, Glidden DV, Rising KL. Promotion of Influenza Vaccination in the Emergency Department. NEJM EVIDENCE 2024; 3:EVIDoa2300197. [PMID: 38776635 DOI: 10.1056/evidoa2300197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Influenza vaccine uptake is low among underserved populations whose primary health care access occurs in emergency departments. We sought to determine whether implementation of two interventions would increase 30-day influenza vaccine uptake in unvaccinated patients in the emergency department. METHODS This three-group, prospective, cluster-randomized controlled trial compared two interventions with a control group in noncritically ill, adult patients in the emergency department who were not vaccinated for influenza in the current vaccine season. The unit of randomization was individual calendar days. Participants received either Intervention M (an influenza vaccine messaging platform consisting of a video, one-page flyer, and scripted message, followed by a vaccine acceptance question and provider notification if participants indicated vaccine acceptance), Intervention Q (no messaging but the vaccine acceptance question and provider notification), or control (usual care/no intervention). The primary outcome was receipt of an influenza vaccine at 30 days ascertained by electronic health record review and telephone follow-up, comparing the Intervention M group with the control group. Secondary outcomes included comparisons of 30-day vaccine uptake in Intervention Q versus control and Intervention M versus Intervention Q. RESULTS Between October 2022 and February 2023, a total of 767 trial participants were enrolled at six emergency departments in five U.S. cities. Median age was 46 years; 353 (46%) participants were female, 274 (36%) were African American, and 158 (21%) were Latinx; 126 (16%) lacked health insurance, and 244 (32%) lacked primary care. The Intervention M, Intervention Q, and control groups had 30-day vaccine uptakes of 41%, 32%, and 15%, respectively (P<0.0001 for Intervention M vs. control). Comparing Intervention M versus Intervention Q, the adjusted difference in 30-day vaccine uptake was 8.7 percentage points (95% confidence interval, -0.1 to 17.6 percentage points). CONCLUSIONS Implementation of influenza vaccine messaging platforms (video clips, printed materials, and verbal scripts) improved 30-day vaccine uptake among unvaccinated patients in the emergency department. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT05836818.).
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Affiliation(s)
- Robert M Rodriguez
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | | | - Zubaid Rafique
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, Seattle
| | - Melanie F Molina
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Efrat Kean
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia
| | | | - Sarah K Bezek
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston
| | | | - James S Ford
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Dana Morse
- Department of Emergency Medicine, University of Washington, Seattle
| | - Jaran White
- Department of Emergency Medicine, Duke University, Durham, NC
| | - Mireya I Arreguin
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Lindsey Shughart
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia
| | - Cecilia Lara Chavez
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Dave V Glidden
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco
| | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia
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Simon EL, Crouse B, Wilson M, Muir M, Sayles S, Ramos C, Phelan MP. Evaluation of missed influenza vaccination opportunities in the emergency department. Am J Emerg Med 2023; 68:59-63. [PMID: 36933335 DOI: 10.1016/j.ajem.2023.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/19/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Seasonal influenza is associated with significant healthcare resource utilization. An estimated 490,000 hospitalizations and 34,000 deaths were attributed to influenza during the 2018-2019 season. Despite robust influenza vaccination programs in both the inpatient and outpatient setting, the emergency department (ED) represents a missed opportunity to vaccinate patients at high risk for influenza who do not have access to routine preventive care. Feasibility and implementation of ED-based influenza vaccination programs have been previously described but have stopped short of describing the predicted health resource impact. The goal of our study was to describe the potential impact of an influenza vaccination program in an urban adult emergency department population using historic patient data. METHODS This was a retrospective study of all encounters within a tertiary care hospital-based ED and three freestanding EDs during influenza season (defined as October 1 - April 30) over a two-years, 2018-2020. Data was obtained from the electronic medical record (EPIC®). All ED encounters during the study period were screened for inclusion using ICD 10 codes. Patients with a confirmed positive influenza test and no documented influenza vaccine for the current season were reviewed for any ED encounter at least 14 days prior to the influenza-positive encounter and during the concurrent influenza season. These ED visits were deemed a missed opportunity to provide vaccination and potentially prevent the influenza-positive encounter. Healthcare resource utilization, including subsequent ED encounters and inpatient admissions, were evaluated for patients with a missed vaccination opportunity. RESULTS A total of 116,140 ED encounters occurred during the study and were screened for inclusion. Of these, 2115 were influenza-positive encounters, which represented 1963 unique patients. There were 418 patients (21.3%) that had a missed opportunity to be vaccinated during an ED encounter at least 14 days prior to the influenza-positive encounter. Of those with a missed vaccination opportunity, 60 patients (14.4%) had subsequent influenza-related encounters, including 69 ED visits and 7 inpatient admissions. CONCLUSION Patients presenting to the ED with influenza frequently had opportunities to be vaccinated during prior ED encounters. An ED-based influenza vaccination program could potentially reduce influenza-related burden on healthcare resources by preventing future influenza-related ED encounters and hospitalizations.
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Affiliation(s)
- Erin L Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron General Ave., Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA.
| | - Bethany Crouse
- Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA; Cleveland Clinic Akron General, Department of Pharmacy, 1 Akron General Ave., Akron, OH 44307, USA
| | - Mackenzie Wilson
- Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA
| | - McKinzey Muir
- Emergency Services Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Stephen Sayles
- Emergency Services Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Chris Ramos
- Emergency Services Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Michael P Phelan
- Emergency Services Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
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Frew PM, Schamel JT, Randall LA, King AR, Spaulding AC, Wu E, Holloway IW. Vaccine confidence among people who use drugs: A cross-sectional survey. Hum Vaccin Immunother 2022; 18:2123201. [PMID: 36170655 DOI: 10.1080/21645515.2022.2123201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Adult immunization coverage remains low in the US, particularly for people who use drugs (PWUD), a population that experiences a disproportionate burden of vaccine-preventable diseases. The extent of and characteristics associated with vaccine confidence (VC) held by PWUD is poorly understood. As VC strongly correlates with vaccine uptake, this cross-sectional study identifies mutable factors associated with VC and quantifies its relationship to immunization status within a highly vulnerable, underimmunized population of PWUD. Using a community-engaged research strategy with select partner organizations hosting syringe exchange programs in Atlanta, Los Angeles, and Las Vegas, USA, we surveyed participants ages 18-69 years served by these organizations from 2019 to 2020. Survey measures included sociodemographics, health behavior including immunization receipt, and vaccine confidence in adult vaccinations using a modified Emory Vaccine Confidence Index (EVCI). The findings reflect relatively low VC among the 1,127 recruited participants, with 56% expressing low VC (EVCI 0-12), 35% medium (EVCI 13-20) and 10% high (EVCI 21-24). EVCI varied by city, with lowest confidence in Atlanta and highest in Las Vegas. VC was associated with past receipt of specific vaccines, including hepatitis A, MMR, Tdap, and influenza. VC varied by specific sociodemographic correlates such as housing insecurity (reduced confidence) and receipt of public benefits or disability (increased confidence). This study identified correlates associated with VC based on site and sociodemographic characteristics for this priority population, highlighting the need for specific interventions to raise VC among PWUD, especially among those experiencing housing insecurity and without public benefits.
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Affiliation(s)
- Paula M Frew
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Jay T Schamel
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Laura A Randall
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Adrian R King
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Anne C Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,Southern California HIV/AIDS Policy Research Center, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,UCLA Hub for Health Intervention, Policy, and Practice, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,Southern California HIV/AIDS Policy Research Center, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,UCLA Hub for Health Intervention, Policy, and Practice, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
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