Clinician Perspective: The Benefit of Prompting Patients into Flu Vaccination

January 8, 2019
Caitlyn Bahrenburg

A lead investigator explains the findings of how active choice intervention in patient's electronic health records helps to increase vaccination rates.

Susan Day, MD, MPH

With influenza (flu) vaccination continuing to be reported at suboptimal rates, researchers are seeking new ways to encourage patients to get vaccinated. One such measure—a recent clinical trial assessing the influence of patient appointment times and an active electronic reminder for scheduling their vaccination on their adherence—looked at a different dimension of the physician-patient vaccination dynamic.

As previously reported by MD Magazine®, the team of investigators from the University of Pennsylvania sought to determine whether flu vaccination rates vary by clinic appointment time and whether an active choice intervention in the electronic health record directed to medical assistants improves vaccination rates in primary care practices.

In a recent interview with MD Mag, lead author Susan Day, MD, MPH, explained the idea behind her team initiating prompts or “nudges” to providers, which would remind them about the annual flu shot in hopes of improving patient vaccination rates.

“There is concern that too many ‘alerts’ in the EMR will cause providers to not pay attention when prodded, but often it is hard to remember to do the simple, basic services, like provide a flu shot, in the middle of a busy office session,” Day said. “We wanted to see if, on balance, it worked.”

The quality improvement study analyzed 11 primary care practices and 96,291 patients. Investigators found that influenza vaccination rates significantly declined as the clinic day progressed. Primary care practices that implemented an active choice intervention in the electronic health record to prompt medical assistants to ask patients about influenza vaccination and template vaccination orders for clinicians to review were associated with a significant increase in influenza vaccination rates, when compared with a control group of primary care practices.

“Providing a nudge did increase the number of patients who got flu shots throughout the day,” Day said.

According to Day, office visits provide an important opportunity to health care professionals to immunize patients. Thus, developing a method of active choice intervention in the electronic health record to prompt medical assistants to ask patients about influenza vaccination while they are already in the office is key for increasing vaccination rates.

“Having a standardized process to remind patients and providers to have the discussion about the importance of getting the flu shot and providing a shot in real time will improve vaccination rates,” Day said.

The end-of-day sharp decrease, which came as a surprise to investigators, is likely a multifactorial issue which needs to be better assessed, Day noted.

“My suspicion is that all parties are fatigued at the end of the day, and it just falls off the radar screen; however, we need to make sure it is easy to do the right thing regardless of the time of the appointment,” she said.

Day stressed the importance of regular flu shots, despite the abysmal vaccination rates which she attributed to a combination of bad press, bad experiences, and a belief on behalf of the patient that they do not need the flu shot because they are healthy.

“Even for healthy, younger patients, it reduces the number of sick days and call outs,” Day said. “Vaccinating healthy younger patients also reduces the risk of transmitting the flu to more vulnerable, older patients.”