Flu Shots Increased by 9.5% With Morning Alerts

People are more receptive to influenza vaccinations in the morning
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(Precision Vaccinations News)

While influenza vaccinations have demonstrated the ability to reduce the number of flu cases, more than 50 percent of adults in the USA do not receive the annual flu shot each year.

 To better understand how to change this behavior, researchers at the University of Pennsylvania Health System conducted a time-of-day study in 11 practices.

They found people who scheduled primary care appointments early in the day are more likely to receive the influenza vaccine, according to a study published in JAMA Network Open. 

In this small study, the Health System increased influenza vaccination rates by implementing digital alerts into the EMR workflow in primary care practices.

The adjusted analyses compared with control practices, the active EMR intervention was associated with a 9.5 percentage increase in vaccination rates.

This 9.5 percent increase was nearly a 20 percent relative increase compared with the pre-intervention period.

But, the vaccination rates significantly declined as the day progressed. At 8 a.m., approximately 44 percent of the patients were vaccinated, and by 3 p.m., vaccination rates declined to just 34 percent.

The reasons for this declined varied but included clinicians falling behind schedule, fewer staff as the day progressed, and patients impatience.

These study findings expand the understanding of how practice environments influence medical decision making in several ways:

  • First, time of day may play an important role in influencing patient care,
  • Second, as medical decision making is increasingly occurring within digital environments, the design and framing of information in the EHR can influence clinician behaviors, and
  • Third, the design of the active choice intervention matters. Before expanding the alert approach to other practices, the decision was made to deliver the alert only to medical assistants. This design increased clarity in who was responsible for addressing the alert and reduced the burden on physicians.

These researchers said ‘Future research could compare the effectiveness of active choice interventions and other types of nudges such as setting EHR defaults through randomized clinical trials and in other settings.’

The University of Pennsylvania institutional review board approved this study and waived informed consent because it was infeasible given the study design, and the study posed minimal risk. This study followed the Standards for Quality Improvement Reporting Excellence (SQUIRE) reporting guideline. These researchers disclosed various industry relationships.

 

 

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