Digital Nudges to Obtain the Flu Shot Fall Short for Vax Rates, Outcomes

— Extra intensive interventions are likely wished to toughen flu vaccine uptake

by
Katherine Kahn, Workers Creator, MedPage Today
March 18, 2024

Digital nudges despatched to patients failed to elevate influenza vaccine uptake in a single randomized clinical trial, whereas another trial came all the map thru that runt will increase in vaccination rates from letters emailed to patients failed to affect clinical outcomes.

Neither portal nor textual say messages to remind patients to web an influenza vaccination were efficient at a inhabitants level at enhancing vaccination uptake, Peter Szilagyi, MD, MPH, of the UCLA Mattel Youngsters’s Sanatorium at the College of California in Los Angeles, and colleagues reported in JAMA Interior Medication. Amongst patients who bought care from Seventy nine main care practices in a gigantic healthcare map, flu shot rates remained at roughly 47% whether patients bought portal messages, textual say messages, or no reminders in any admire.

And in an evaluation of the Danish NUDGE-FLU trial, an about 1% boost in influenza vaccination connected to e mail letters encouraging patients to web vaccinated did now not translate into improvements in cardiovascular, respiratory, or other clinical endpoints, Niklas Johansen, MD, of the Copenhagen College Sanatorium-Harlev and Gentofte in Denmark, and colleagues wrote in the Annals of Interior Medication.

Most likely Advantage to Textual say Messages

Szilagyi and investigators came all the map thru that affected person portal messages despatched monthly or before scheduled visits did now not elevate influenza vaccination rates.

Then another time, preappointment reminders despatched 24 to 48 hours before a scheduled main care appointment, by either textual say or affected person portal, had a microscopic sure enact on vaccine uptake (adjusted possibility ratio [aRR] 1.04, 95% CI 1.01-1.06, P=0.01) in a subgroup of patients who were unvaccinated but had a minimum of one main care appointment. This enact gave the affect to be driven by textual say preappointment reminders, which be pleased been connected to an absolute elevate in vaccination rates of 1.6-1.8% (aRR 1.07, P=0.002), whereas the portal preappointment reminders had no important affect.

“We suspect there are several the reason why textual say, but no longer portal, preappointment reminders were efficient,” Szilagyi and colleagues wrote. “Portal messages require patients to originate the portal and gain and then be taught the message, whereas textual say messages seem straight away and can seem more urgent or important.”

Given the results of their search for, the authors concluded that “textual say message preappointment reminders can even be efficient for patients with scheduled appointments,” but successfully being programs could most likely opt for more intensive interventions as another, “equivalent to enhancing entry to vaccinations (e.g., Saturday or after-hours clinics) or verbal exchange practising for clinicians to take care of vaccine hesitancy.”

The trial incorporated patients 6 months of age or older in the UCLA Correctly being Machine with either one or two visits to a chief care provider within the past year or who were enrolled in managed care within the map. The trial incorporated 262,085 patients, 9% of whom where adolescence. Mean age used to be forty five years: females accounted for 57% of contributors, fifty three% were white, 12% were Hispanic or Latino, and 10% were Asian. Most (83.5%) had deepest successfully being insurance, and 14.9% bought Medicare. About 65% had bought an influenza vaccination within 2 years.

Sufferers were randomized equally to receive customary of care, influenza vaccine portal reminders, or vaccine textual say reminders. Those randomized to the portal reminder community were further randomized to receive fastened or responsive monthly portal reminders, with or without preappointment reminders. Those randomized to the textual say reminder community bought fastened monthly reminders and were further randomized to receive preappointment reminders or no preappointment reminders.

The main final consequence used to be influenza vaccination, together with vaccination at pharmacies and other sites.

NUDGE-FLU Evaluation

Previously, the Danish NUDGE-FLU trial came all the map thru that electronic letters that nudged recipients to web vaccinated for influenza and additionally equipped information on its cardiovascular advantages (so-referred to as “abolish-framing”) were connected to a microscopic elevate of about 1% in flu vaccine uptake.

On this prespecified clinical final consequence evaluation of that trial, no statistically important variations in clinical outcomes were came all the map thru among other folks that bought a letter that incorporated cardiovascular abolish-framing or in other folks that bought repeated letters, when put next with the customary care community who bought no letters, reported Johansen and co-authors.

Hospitalization for pneumonia or influenza used to be 1% in the customary care community, 1% in the community that bought the letters with cardiovascular abolish-framing, and 1.1% in the repeated-letter community. Hospitalization for any motive used to be roughly 13% in all three groups. Mortality all the map thru the search for occurred in 1.8% of the customary care community, 1.9% in the abolish-framing community, and 1.7% in the repeated-letter community.

Given the modest results of the usual NUDGE-FLU trial, the findings of the prespecified evaluation got here as no surprise to Label Fendrick, MD, of the College of Michigan Scientific School in Ann Arbor.

“It isn’t that the flu shot doesn’t work, it be that an intervention that got a truly microscopic [number] of further other folks to web the flu shot did now not fabricate a particular final consequence enact all the map thru the total inhabitants,” Fendrick told MedPage Today. “I could no longer keep a question to an further 1% of a inhabitants getting the flu shot to in fact expose meaningfully clinical final consequence variations.”

“There’s pleasing sturdy evidence to expose that reasonably a fashion of these [vaccine] reminders are no longer terribly efficient,” he added.

Johansen told MedPage Today by the recount of e mail that his community wasn’t bowled over either. “We were successfully conscious that our nudging letters excellent resulted in modest will increase in influenza vaccination, and we therefore suspected that the distinction in vaccination rates would no longer be sufficient to force a distinction in clinical outcomes.”

In the usual NUDGE-FLU trial, roughly 965,000 Danish contributors were randomized to customary care or to receive one of nine totally different electronically delivered behavioral nudging letters all the map thru the 2022-2023 flu season. The most original evaluation incorporated 691,820 contributors of that trial who were 65 years of age or older. Since the usual NUDGE-FLU trial came all the map thru that repeated customary letters and cardiovascular abolish-framing letters resulted in modest but considerably bigger rates of influenza vaccination, the most original evaluation fascinated about comparison of the groups that bought no letters, letters despatched at baseline and 14 days later, and cardiovascular abolish-framed letters.