Patient Portal Reminders for Pediatric Influenza Vaccinations: A Randomized Clinical Trial

Abstract

OBJECTIVES In a large health system, we evaluated the effectiveness of electronic health record patient portal reminders in increasing pediatric influenza vaccination rates. METHODS We conducted an intention-to-treat randomized clinical trial of 22 046 children from 6 months to <18 years of age in 53 primary care practices. Patients (or parent and/or proxies) who were active portal users were randomly assigned to receive reminder messages framed as gains or losses or no messages. They were separately randomly assigned to receive a precommitment message before the influenza season. The primary outcome was receipt of ≥1 seasonal influenza vaccinations. Additionally, children 6 months to <3 years of age due for a second influenza vaccine were randomly assigned to receive a reminder or no reminder for the second vaccination. RESULTS First-dose influenza vaccination rates were 56.9% in the control group, 58.0% in the loss-frame reminders group (P = .07), and 58.0% in the gain-frame group (P = .47). Rates were 58.3% in the precommitment group versus 57.0% in the control group (P = .11). Adjusted risk ratios for first vaccination were 1.02 (95% confidence interval [CI]: 1.00–1.04) for loss-frame reminders, 1.01 (95% CI: 0.98–1.05) for gain-frame reminders, and 1.02 (95% CI: 1.00–1.04) for precommitment messages versus controls. Second-dose vaccination rates were 44.1% in the control group and 55.0% in the reminder group, with an adjusted risk ratio of 1.25 (95% CI: 1.07–1.45). CONCLUSIONS Patient portal reminders for influenza vaccines in children, whether framed as gains or losses, did not increase first-dose influenza vaccination rates but were highly effective for the second dose of the vaccine.

Effect of Outreach Messages on Adolescent Well-Child Visits and Coronavirus Disease 2019 Vaccine Rates: A Randomized, Controlled Trial

“…Reminders were not effective at increasing initiation in a large pediatric study, regardless of whether the message was framed as gains or losses, but reminders did promote completion among those who needed a second shot. 39 In contrast, reminder messages to adults who already had a visit scheduled were effective at increasing flu vaccine rates, with the most effective messages framed as “a vaccine has been reserved for you.” 29 In addition to outreach, effective communication approaches are needed to engage vaccine hesitant adolescents and their parents during visits. 32 It is unclear whether past approaches to address vaccine hesitancy when discussing routine childhood vaccines 40 will remain effective in the context of COVID-19 vaccine.…”

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.…”

COVID-19 and Routine Childhood Vaccinations—Identifying Gaps and Informing Solutions

“…Although there are concerns regarding adoption of portals among underserved populations, emerging evidence suggests portal-based vaccine reminders can lead to small but significant gains in vaccination. 11 At the community level, pediatric health care systems can partner with alternative settings to promote vaccination. Pediatricians and pediatric clinicians will remain front and center in these efforts.…”