Flu Vaccine Uptake Tripled With Simple Promotion – Medpage Today

A few simple interventions boosted flu vaccine uptake for patients waiting at the emergency department [ED], according to the cluster-randomized, controlled PROFLUVAXED trial.

People in ED waiting areas who consented to view a 3-minute video with a scripted message, read a one-page flyer, and have a short discussion with an ED clinician about the flu vaccine had a 30-day follow-up vaccination rate of 41% versus 15% among patients that received no messaging about the vaccine.

Even just asking people in the ED "Would you accept the influenza vaccine in the emergency department today if your doctor asked you to get it?" resulted in a 30-day vaccination rate of 32%, Robert Rodriguez, MD, of the University of California San Francisco, and colleagues reported in NEJM Evidence.

"We fully expected the interventions to improve vaccine uptake but were surprised by how effective they were," Rodriguez told MedPage Today. "The simple question intervention doubled vaccine uptake and the messaging intervention nearly tripled vaccine uptake."

"There is a distinctly underserved population whose primary (and often only) healthcare access occurs in emergency departments," Rodriquez noted. "To decrease disparities, public health interventions, especially vaccine messaging and vaccine administration, can and should be delivered in emergency departments."

To ensure the messages in the video and flyer reached medically underserved populations, researchers created five different versions with the same wording that featured African American, Latinx (English and Spanish versions), multiracial, or white physicians.

The consequences of poor influenza vaccine uptake are particularly stark for members of racial and ethnic minority groups, Zanthia Wiley, MD, and Annelys Roque Gardner, MD, both of Emory University School of Medicine in Atlanta, wrote in an accompanying editorial. Black, Hispanic, and American Indian or Alaska Native adults have age-adjusted influenza hospitalization rates of 1.2 to 1.8 times the rate of non-Hispanic white adults, they noted. Moreover, it is common for people who lack health insurance and access to primary care to visit EDs for non-emergency care, they pointed out.

"Exploring alternative methods of promoting vaccinations in racial and ethnic minority communities and for those individuals who have limited access to routine healthcare is essential for vaccine equity," Wiley and Gardner wrote.

The PROFLUVAXED trial enrolled 767 participants from six emergency departments in San Francisco, Houston, Philadelphia, Seattle, and Durham, North Carolina from October 2022 to February 2023. No participant was critically ill and the majority of ED visits were for conditions that would not preclude offering and administering vaccines. Forty-six percent of participants were female, 36% African American, and 21% Latinx. Sixteen percent had no health insurance, approximately one-third did not have a primary care physician, and 9% were unhoused or marginally housed.

All participants filled out a consent and intake survey and were then randomized to one of three groups. Participants in the first group (Intervention M, n=210) were asked to view the video and flyer and have a discussion with an ED clinician about the flu vaccine. Participants in the second group (Intervention Q, n=244) were asked if they would accept a flu vaccine if offered. The control group (n=313) received no intervention. Researchers used data from electronic health records for a period of 30 days post-intervention to determine if participants received the flu vaccine, or were contacted with a follow-up phone call.

Similar percentages of participants in the intervention groups said they would accept the flu vaccine in the ED (49% in M vs 45% in Q) and similar percentages also received the flu vaccine during their index ED visit (27% and 24%, respectively). However, nearly one-half of participants who said they were willing to receive the vaccine in the ED did not receive it at the index visit. The main reason for participants not receiving the vaccine at the index ED visit were clinicians not ordering or administering the vaccine.

One limitation of the study was that research coordinators delivered the vaccine messages in the intervention groups. These staff are unlikely to be available in most EDs, especially ones with limited resources, the authors pointed out. Also, all the sites participating in the study were urban academic EDs, so the study results may not be generalizable to rural or community EDs, they concluded.

Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.

Disclosures

The study was funded by the National Institute of Allergy and Infectious Diseases.

Rodriguez reported a relationship with the Pfizer Foundation; other study authors reported ties to industry.

Wiley and Gardner reported no ties to industry.

Primary Source

NEJM Evidence

Source Reference: Rodriguez RM, et al "Promotion of influenza vaccination in the emergency department" NEJM Evid 2024; DOI:10.1056/EVIDoa2300197.

Secondary Source

NEJM Evidence

Source Reference: Wiley Z and Gardner AR "Adult influenza vaccination -- seizing every opportunity" NEJM Evid 2024; DOI: 10.1056/EVIDe2400032.

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Flu Vaccine Uptake Tripled With Simple Promotion - Medpage Today