Patients were 28 percent more likely to get a flu shot when they got a text message reminder and their primary care provider already had an order for the shot waiting, new research from the Perelman School of Medicine showed. The study was published in JAMA Internal Medicine.
“This is important given the rise in vaccine hesitancy, which has resulted in a downward trend in flu vaccination that coincided with a high rate of hospitalization this flu season,” said the study’s lead author, Shivan Mehta, MD, MBA, MSHP, associate chief innovation officer at Penn Medicine. “Many nudge interventions directed to patients only on vaccinations have shown limited effectiveness in the United States, so we wanted to make sure that we addressed both sides of the exam room: the patient and the clinician.”
The researchers believe these results might point to some strategies that could help boost how many people get the shot every year for an illness that has hospitalized up to 710,000 people each year since 2010—and killed as many as 52,000 Americans annually.
The study tested several forms of “nudging,” a behavioral science concept that means small tweaks that make the healthiest choices the easiest ones. Patients who were eligible for the vaccine received flu shot reminder texts (or automated voice recordings), had automatic orders for a flu shot waiting for their clinician to approve, and monthly personalized messages were sent to providers that compared their patients’ vaccination rates to their clinician peers.
More than 52,000 people were randomly assigned to two groups: one that received all of the nudges or a “standard care” control group at either the University of Pennsylvania Health System or the University of Washington’s health system, UW Medicine The standard care team didn’t get any of the nudges and followed the usual path for getting a flu vaccine, which relies largely on the clinician remembering to offer the vaccine based on information in the electronic health records. Researchers found that almost 3,000 more people got flu shots when they were nudged than would have been expected if they got normal care.
Mehta and his colleagues are encouraged by their findings, driven mainly by the importance of communication and trust.
“We think the automatic order encouraged primary care physicians to have a conversation with their patients, and we know these clinicians still have a lot of trust from their communities,” said co-senior author Amol Navathe, MD, PhD, a professor of medical ethics and health policy, as well as a professor of healthcare management in the Wharton School.
The team has replicated their work at Lancaster General Health in the University of Pennsylvania Health System, which serves a rural and suburban patient base that looks somewhat different than the study populations in this study drawn largely from Philadelphia and Seattle. They are still analyzing the results of this replication study.
Since the work leverages existing tools in the electronic health record along with other available technologies but no additional staffing or human effort, it could be particularly attractive to health systems looking to augment their flu shot efforts.
“Future interventions could be more successful by complementing the automated communication with clinical staff to engage with patients that are still hesitant, and integrating flu vaccine nudges with other interventions focused on preventive health, like cancer screening,” Mehta said.
Source: Perelman School of Medicine