Patients who received both a text message reminder and had a pre-ordered flu shot from their primary care provider were 28 percent more likely to get vaccinated, according to new research from the Perelman School of Medicine. The study, published in JAMA Internal Medicine, examined how combining nudges directed at both patients and clinicians could improve vaccination rates.
“This is important given the rise in vaccine hesitancy, which has resulted in a downward trend in flu vaccination that coincided with a high rate of hospitalization this flu season,” said Shivan Mehta, MD, MBA, MSHP, associate chief innovation officer at Penn Medicine. “Many nudge interventions directed to patients only on vaccinations have shown limited effectiveness in the United States, so we wanted to make sure that we addressed both sides of the exam room: the patient and the clinician.”
Researchers tested several behavioral nudges among more than 52,000 people across two health systems: University of Pennsylvania Health System and UW Medicine. Participants were randomly assigned either to receive all nudges or standard care. Nudges included automated reminders for patients about flu shots and automatic orders for clinicians to approve during visits. Monthly personalized messages were also sent to providers comparing their patient vaccination rates with those of peers.
The control group received usual care based primarily on clinicians remembering to offer vaccines using electronic health record information. The intervention led nearly 3,000 additional people to get vaccinated compared with what would be expected under standard care.
“We think the automatic order encouraged primary care physicians to have a conversation with their patients, and we know these clinicians still have a lot of trust from their communities,” said Amol Navathe, MD, PhD, co-senior author and professor at both the Perelman School of Medicine and Wharton School.
The approach has since been replicated at Lancaster General Health within Penn Medicine’s system. This extension targets rural and suburban populations distinct from those initially studied in Philadelphia and Seattle; results are still being analyzed.
Because these interventions rely on existing electronic health record tools without requiring extra staff or significant resources, they may appeal broadly to other health systems aiming to increase flu vaccination rates.
“Future interventions could be more successful by complementing the automated communication with clinical staff to engage with patients that are still hesitant, and integrating flu vaccine nudges with other interventions focused on preventive health like cancer screening,” Mehta said.
