Original Investigation
March 18, 2024
Text vs Patient Portal Messaging to Improve Influenza Vaccination Coverage: A Health System–Wide Randomized Clinical Trial
Peter G. Szilagyi, O. Kenrik Duru, Alejandra Casillas, et al
JAMA Intern Med. Published online March 18, 2024. doi:10.1001/jamainternmed.2024.0001
Question Can either patient portal or text message reminders to patients about influenza vaccination raise vaccination rates across a health system, and do text messages work better than portal messages?
Findings In this 3-arm randomized clinical trial that included 262 085 patients in 79 primary care practices, neither portal nor text message patient reminders were successful in raising overall influenza vaccination rates.
Meaning Health systems and health care professionals need to implement more intensive interventions than patient reminders to raise influenza vaccination rates.
Abstract
Importance Increasing influenza vaccination rates is a public health priority. One method recommended by the US Centers for Disease Control and Prevention and others is for health systems to send reminders nudging patients to be vaccinated.
Objective To evaluate and compare the effect of electronic health record (EHR)–based patient portal reminders vs text message reminders on influenza vaccination rates across a health system.
Design, Setting, and Participants This 3-arm randomized clinical trial was conducted from September 7, 2022, to April 30, 2023, among primary care patients within the University of California, Los Angeles (UCLA) health system.
Interventions Arm 1 received standard of care. The health system sent monthly reminder messages to patients due for an influenza vaccine by portal (arm 2) or text (arm 3). Arm 2 had a 2 × 2 nested design, with fixed vs responsive monthly reminders and preappointment vs no preappointment reminders. Arm 3 had 1 × 2 design, with preappointment vs no preappointment reminders. Preappointment reminders for eligible patients were sent 24 and 48 hours before scheduled primary care visits. Fixed reminders (in October, November, and December) involved identical messages via portal or text. Responsive portal reminders involved a September message asking patients about their plans for vaccination, with a follow-up reminder if the response was affirmative but the patient was not yet vaccinated.
Main Outcomes and Measures The primary outcome was influenza vaccination by April 30, 2023, obtained from the UCLA EHR, including vaccination from pharmacies and other sources.
Results A total of 262 085 patients (mean [SD] age, 45.1 [20.7] years; 237 404 [90.6%] adults; 24 681 [9.4%] children; 149 349 [57.0%] women) in 79 primary care practices were included (87 257 in arm 1, 87 478 in arm 2, and 87 350 in arm 3). At the entire primary care population level, none of the interventions improved influenza vaccination rates. All groups had rates of approximately 47%. There was no statistical or clinically significant improvement following portal vs text, preappointment reminders vs no preappointment reminders (portal and text reminders combined), or responsive vs fixed monthly portal reminders.
Conclusions and Relevance At the population level, neither portal nor text reminders for influenza vaccination were effective. Given that vaccine hesitancy may be a major reason for the lack of impact of portal or text reminders, more intensive interventions by health systems are needed to raise influenza vaccination coverage levels.
Trial Registration ClinicalTrials.gov Identifier: NCT05525494
