Patients with morning appointments are more likely to be vaccinated against influenza

According to the results of the study published today in JAMA Network Open.

The researchers found that implementing a "boost" intervention in several primary care practices within the health care system of the University of Pennsylvania globally increased influenza vaccination rates, but that the effect decreased during the day.

"Patients who see their doctor later in the day were less likely to be vaccinated against the flu" Mitesh S. Patel, MD, MBA, director of the Penn Medicine Nudge unit and assistant professor of medicine and health care management at the Perelman School of Medicine and at the Wharton School of the University of Pennsylvania, said Infectious Diseases News. "This result is important to recognize because primary care practices are looking for ways to improve immunization rates."

At around 40 percent, influenza vaccination rates in the US are "suboptimal," Patel and his colleagues wrote. For their study, they examined whether vaccination rates could be increased by using an active choice intervention – a "push" – in the electronic health record for medical assistants and whether immunization rates varied according to the type of immunization. 39, appointment time.

They conducted a retrospective Quality Improvement Study between September 1, 2014 and March 31, 2017, enrolling eligible adults in influenza immunization with 11 primary care practices in the health care system. University of Pennsylvania. The intervention was implemented in three internal medicine clinics during the 2016-2017 influenza season.

According to Patel and colleagues, current pre-intervention practice required primary care providers to manually check the influenza vaccine status of the patient, discuss it with them, and place a vaccination order in the EHR. During the study period, an active choice intervention in the EHR led medical assistants to ask clinicians to check their vaccination status and model vaccination orders in the EHR.

Patel and colleagues reported an overall increase in vaccination rates of 9.5 percentage points, but rates dropped significantly during the day. From 8 am to 10 am, vaccination rates were about 44% over the full 3 years and among all practices. They fell to 41.2% at 11 am and 38.3% at noon. At 1 pm, rates rose to 40.2 percent, but declined to 34.3 percent at 15 hours. and 32% at 16 hours (P <0.001).

In control practices, the first year vaccination rates were 46.9%; in the second year they were 47.2%; and in the third year, 45.6%, according to the study. The 3-year vaccination rates for intervention practices were 49.7%, 52.2% and 59.3%, respectively.

"A boost in the electronic health record can help boost flu shot rates in general, but more study is needed to change the decline during the day," Patel said.

He said the decline may be due to several factors, such as late clinicians and patient visits, declining staff numbers as the day progresses, or patients wishing to return home earlier.

"It could also be due to a phenomenon called decision fatigue, which is the cumulative result of repeated decisions that lead clinicians to stop questioning patients about the vaccine later in the day," he says. declared.

Patel and his colleagues said the intervention "could be a promising approach to improve medical decision-making behavior." However, they pointed out that further research on the association between the time of day and vaccination rates is essential. – by Marley Ghizzone

Disclosures: Patel reports receiving support from the Department of Veterans Affairs' Health Services Research and Development Service and the Doris Duke Charitable Foundation; being the founder of Catalyst Health and a consulting firm in technology and behavior change; receive Deloitte research funds not related to this study; receive personal fees from Catalyst Health; and member of the Advisory Board of HealthMine Services, Life.io and Holistic Industries. Please consult the study for all relevant financial information of other authors.