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Patient Portal Reminders for Pediatric Influenza Vaccinations: A Randomized Clinical Trial
Carlos Lerner1, Christina Albertin2, Alejandra Casillas3
1Department of Pediatrics and Mattel Children's Hospital clerner@mednet.ucla.edu.
Insights
Electronic health record patient portal reminders did not increase first-dose pediatric influenza vaccination rates. However, these reminders were highly effective in increasing the rate of second-dose influenza vaccinations in young children.
Area of Science:
- Public Health
- Preventive Medicine
- Health Informatics
Background:
- Influenza vaccination is crucial for pediatric health.
- Patient portals offer a platform for health interventions.
- Optimizing vaccination strategies is an ongoing public health priority.
Purpose of the Study:
- To evaluate the effectiveness of electronic health record patient portal reminders in improving pediatric influenza vaccination rates.
- To compare different reminder message frames (gain vs. loss) and precommitment strategies.
- To assess the impact of reminders on both first and second influenza vaccine doses.
Main Methods:
- A randomized clinical trial involving 22,046 children aged 6 months to 17 years across 53 primary care practices.
- Active patient portal users were randomized to receive gain-frame, loss-frame, or no reminder messages.
- A subset of children due for a second influenza vaccine received targeted reminders.
Main Results:
- First-dose influenza vaccination rates did not significantly differ between reminder groups and the control group (range: 56.9%-58.3%).
- Adjusted risk ratios for first vaccination ranged from 1.00 to 1.04, indicating no substantial increase.
- Second-dose vaccination rates were significantly higher in the reminder group (55.0%) compared to the control group (44.1%), with an adjusted risk ratio of 1.25.
Conclusions:
- Electronic health record patient portal reminders are not effective in increasing initial pediatric influenza vaccination uptake.
- Targeted reminders for the second dose of the influenza vaccine significantly improve vaccination rates in young children.
- Future interventions should consider tailored approaches for different vaccination stages.
Objectives:
In a large health system, we evaluated the effectiveness of electronic health record patient portal reminders in increasing pediatric influenza vaccination rates.
Methods:
We conducted an intention-to-treat randomized clinical trial of 22 046 children from 6 months to <18 years of age in 53 primary care practices. Patients (or parent and/or proxies) who were active portal users were randomly assigned to receive reminder messages framed as gains or losses or no messages. They were separately randomly assigned to receive a precommitment message before the influenza season. The primary outcome was receipt of ≥1 seasonal influenza vaccinations. Additionally, children 6 months to <3 years of age due for a second influenza vaccine were randomly assigned to receive a reminder or no reminder for the second vaccination.
Results:
First-dose influenza vaccination rates were 56.9% in the control group, 58.0% in the loss-frame reminders group (P = .07), and 58.0% in the gain-frame group (P = .47). Rates were 58.3% in the precommitment group versus 57.0% in the control group (P = .11). Adjusted risk ratios for first vaccination were 1.02 (95% confidence interval [CI]: 1.00-1.04) for loss-frame reminders, 1.01 (95% CI: 0.98-1.05) for gain-frame reminders, and 1.02 (95% CI: 1.00-1.04) for precommitment messages versus controls. Second-dose vaccination rates were 44.1% in the control group and 55.0% in the reminder group, with an adjusted risk ratio of 1.25 (95% CI: 1.07-1.45).
Conclusions:
Patient portal reminders for influenza vaccines in children, whether framed as gains or losses, did not increase first-dose influenza vaccination rates but were highly effective for the second dose of the vaccine.
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