Influenza vaccination rates in clinics are declining as the day progresses, but nudges give them a boost

According to Penn Medicine researchers, primary care clinics experienced a significant decline in influenza vaccines during the day. JAMA Open Network. The study suggests, however, that "pushing" clinical staff to order vaccines using a behavioral economy technique known as "active choice" could help stem this decline. The study is the first to show how clinic appointments can influence influenza vaccination rates.

"As the day progresses, clinicians can spend less time discussing the vaccine with patients," said lead author Rebecca Kim, MD, MPH, resident physician of Penn Medicine. "Our results show that the time of day is an important factor in vaccination rates and could help guide the design of future interventions to improve immunization rates."

The researchers found that vaccination rates had dropped significantly during the day in 11 health system clinics of the University of Pennsylvania over a three-year period (2014-2017), from 44% to 8am at 32% at 16h.

In the third year, the team gave a boost to the electronic health record of three clinics, which led medical assistants to "accept" or "refuse" a vaccination order for eligible patients. . They found that the intervention was associated with a 9.5% increase in immunizations, which represents a relative increase of almost 20% compared to non-intervention practices.

"In the United States, influenza vaccination rates have been below 40% for nearly a decade," said Mitesh S. Patel, MB, lead author of the study, assistant professor of medicine and director of the Penn Medicine Nudge unit. "Our study indicates that nudges in the EHR could be an effective and scalable approach to increasing immunization in the context of primary care."

Although rates improved with the boost, they still decreased as the day progressed, suggesting that other strategies may be needed to cope with variations in care according to the plan. ;hour. The research is based on a study conducted in 2017 by the same team who found that setting up a "boost" in the EHR was associated with a six percent increase in flu shots compared to practices without intervention. The researchers not only included more practice in the latest study, but also drew attention to medical assistants, rather than physicians, to eliminate redundancy, which may have contributed to improved immunization rates .

"Importantly, this intervention was directed to the staff, not the clinicians," said Patel. "At a time when doctors are often overloaded with alerts and are faced with burnout, these types of well-designed nudges can address these issues while improving patient care," said Patel. .

Next, researchers aim to extend the "push" intervention to more primary care practices within the health system to study and improve the approach. If these types of interventions were implemented in the 36 primary care practices, for example in Philadelphia and the suburbs, researchers estimate that an additional 5,000 patients would be vaccinated within a year.

The concept of "nudging" comes from the field of behavioral economics and involves intervening, often in a subtle way, to improve decision-making and, ultimately, patient care. Patel and his colleagues at the Penn Nudge Medicine Unit in previous research have shown the benefit of nudge strategies in a wide range of areas, including opioid prescribing behavior, cancer screening and, more recently, cholesterol-lowering statins.

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