Patient Portal Reminders Increase Flu Vaccination Rates

Peter Szilagyi, MD, MPH

Findings of a recent analysis showed generic patient portal reminders were effective in minimally increasing influenza (flu) vaccination rates.

The results from Peter Szilagyi, MD, MPH, and colleagues, however, emphasized the need for more intensive or targeted patient motivational strategies.

The team performed the four-arm randomized clinical trial across the University of California, Los Angeles system to evaluate the effect of patient reminders sent through an electronic health record (EHR) patient portal on flu vaccination rates. Szilagyi and the investigators included 164,205 patients in the study.

The patients were randomized within primary care practices to 1 of 4 study arms: no reminder (41,070 patients), 1 reminder (41,055 patients), 2 reminders (41,046 patients), or 3 reminders (41,034 patients).

Any ULCA Health System primary care patient who was >6 months old at intervention launch was included. Patients needed to have >2 primary care physician visits within 3 years or >1 primary care physician visit with a preventive service code within 1 year. The investigators identified active portal users who signed up for and logged into the portal >1 time during the prior 12 months.

Two investigators sent files to the healthcare system’s patient portal team, defining the messages to be sent. Patients then received a notification by email or text message based on their preference. The notification informed patients a message from their doctor had been posted on the portal. Flu vaccination was not mentioned in the message title, so patients had to log in and read the letter.

The letter included information regarding the upcoming flu season, and the disease could cause substantial morbidity. What’s more, it provided a recommendation to receive a vaccination by calling for an appointment or going to a pharmacy. The letter had a website link to input vaccinations received elsewhere into their UCLA Health System record and another link to a webpage with information about flu vaccine and video testimonials about flu vaccination.

Through the EHR, Szilagyi and the team obtained information on each participant’s flu vaccinations administered at any UCLA Health System site.

The main outcome of the study was EHR-based documentation of >1 flu vaccine. Additional outcomes included flu vaccination rates among subgroups and vaccinations self-reported by patients in reply to the portal-based query as having gotten a vaccine elsewhere.

Overall, 164,205 patients with a mean age of 46.2 years old and a majority (58.3%) female, were randomized into 1 of the 4 study arms. Across all ages and not including self-reported vaccinations, rates were 37.5% for those who did not receive reminders, 38% for those who received 1 reminder (P = .008 vs no reminder), 38.2% for those who received 2 reminders (P = .03 vs no reminder), and 38.2% for those who received 3 reminders (P = .02 vs no reminder).

In a secondary analysis without self-reported vaccinations, patients 18-64 years old (vaccination rates: 32% in the control group, 32.8% in the 1 reminder group, 32.8% in the 2 reminder group, and 32.8% in the 3 reminder group; P = .001), male patients (37.3%; 38.3%; 38.6%; 38.8%; P = .001), non-Hispanic patients (37.6%; 38.2%; 38.3%; 38.2%; P = .004), and those who were not vaccinated in the prior 2 years (vaccination rates: 15.3%; 15.9%; 16.3%; 16.1%; P <.001), vaccination rates were higher in the portal reminder groups.

After including the self-reported vaccinations, flu vaccination rates were 1.4-2.9 percentage points higher in the reminder groups, with a dose-response effect (0 reminders: 15,537 [37.8%]; 1 reminder: 16,097 [39.2%]; 2 reminders: 16,426 [40%]; and 3 reminders: 16,714 [40.7%]; P <.001).

The study helped capture more complete flu vaccination data for the healthcare system because of the understanding of additional vaccinations self-reported due to the portal reminders. The approach could benefit healthcare systems facing value-based incentives, investigators wrote. Additional research is needed to improve the effect of reminders for flu vaccination.

The study, “Effect of Patient Portal Reminders Sent by a Health Care System on Influenza Vaccination Rates,” was published online in JAMA Internal Medicine.