Effect of Personalized Messages Sent by a Health System’s Patient Portal on Influenza Vaccination Rates: a Randomized Clinical Trial

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).

Effect of Electronic Outreach Using Patient Portal Messages on Well Child Care Visit Completion

“…9 Future qualitative research should be done to ( 1 Past research on patient portal messages has largely examined its use among adult, non-Hispanic White, and privately insured populations. [18][19][20][21][22][23] In contrast, our study examined the use of patient portal messages among predominantly low-income non-Hispanic Black pediatric patients, a traditionally marginalized and harder to reach population. We conducted a separate trial with patients with an inactive EHR portal account to examine text and telephone reminder messages in that population, and rates of WCC completion were lower, ranging from 10% to 14%.…”

“…Past research on patient portal messages has largely examined its use among adult, non-Hispanic White, and privately insured populations . In contrast, our study examined the use of patient portal messages among predominantly low-income non-Hispanic Black pediatric patients, a traditionally marginalized and harder to reach population.…”

“…Portal use in pediatric and adult primary care settings has increased since 2008. 15 , 16 , 17 Portal reminders to schedule influenza vaccines among pediatric 18 , 19 and adult 20 , 21 , 22 , 23 patients have been minimally effective. Portal messages have successfully increased the scheduling, but not completion, of wellness visits among adults.…”

Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients

“…Whereas another study using Epic MyChart patient portal messaging for late-season Influenza vaccination found no significant differences in vaccination uptake between the intervention and control groups [23]. Another recent study found no effect of tailored reminders (based on demographics with behavior economic messaging) sent by a health system's patient portal on influenza vaccination rates and a minimal effect (4.5%) among the young adult patient group who opened the pre-commitment portal messages asking if they planned to get vaccinated [34].…”

“…We created customized electronic reminder messages that pair strong provider recommendations with brief education and emphasis on the importance and cancer prevention, a recommended strategy for strengthening provider communication about HPV vaccination [18]. To our knowledge, this is the first study to include a patient's specific provider's name as part of the electronic patient reminder, rather than the organization's name [34].…”