Influenza immunization in a managed care organization (original) (raw)
Related papers
2004
OBJECTIVE To evaluate the incremental effect of a second client reminder postcard or an influenza tool kit targeted toward employers on increasing influenza vaccination rates among adults age < 65 years at high risk for complications from influenza illness. METHODS In this demonstration study, enrollees of 3 managed care organizations (n = 8881) were randomized at the employer level into 4 arms: 1 postcard, 2 postcards, 1 postcard + tool kit, and 2 postcards + tool kit. The postcards and tool kits were mailed during the fall of 2001, and their effect on influenza vaccination rates was assessed through a survey. RESULTS Compared with a single postcard, 2 postcards increased vaccination rates by 4 percentage points (adjusted relative risk = 1.05; P < .05) among persons aged 50 to 64 years but did not have any effect among younger adults. Older adults had a greater burden of disease and reported more favorable knowledge and attitudes toward the influenza vaccine. The influenza to...
Journal of the American Medical Informatics Association, 1999
The authors conducted a prospective study of clinicians' influenza vaccination behavior over four years. Approximately one half of the clinicians in an internal medicine clinic used a computer-based patient record system (CPR users) that generated computer-based reminders. The other clinicians used traditional paper records (PR users). Measurements: Each nonacute visit by a patient eligible for an influenza vaccination was considered an opportunity for intervention. Patients who had contraindications for vaccination were excluded. Compliance with the guideline was defined as documentation that a clinician ordered the vaccine, counseled the patient about the vaccine, offered the vaccine to a patient who declined it, or verified that the patient had received the vaccine elsewhere. The authors calculated the proportion of opportunities on which each clinician documented action in the CPR and PR user groups. Results: The CPR and PR user groups had different baseline compliance rates (40.1 and 27.9 per cent, respectively; P < 0.05). Both rates remained stable during a two-year baseline period (P = 0.34 and P = 0.47, respectively). The compliance rates in the CPR user group increased 78 per cent from baseline (P < 0.001), whereas the rates for the PR user group did not change significantly (P = 0.18). Conclusions: Clinicians who used a CPR with reminders had higher rates of documentation of compliance with influenza-vaccination guidelines than did those who used a paper record. Measurements of individual clinician behavior at the point of each clinical opportunity can provide precise evaluation of interventions that are designed to improve compliance with guidelines.
Archives of family medicine, 2000
To determine if postcard and telephone reminders increased the rate of influenza immunization of Medicare beneficiaries. Before and after trial (postcard reminders) with systematically allocated control group (telephone reminder intervention). A semirural family practice residency program. All 475 noninstitutionalized persons older than 65 years who had received at least 1 office service in the previous 2 years. In September 1996, each of 475 patients received a postcard urging prompt influenza immunization. Those not responding within 1 month were systematically allocated either to a group receiving further telephone contact or to a control group. At the time of telephone contact, any offered information about influenza immunization received outside the Smoky Hill Family Practice Center, Salina, Kan, was recorded. We measured the percentage of change in practice-administered influenza immunizations compared with the baseline rate of the preceding 2 years; the difference in immuniza...
Postcard reminders from GPs for influenza vaccine: Are they more effective than an ad hoc approach?
Australian and New Zealand Journal of Public Health, 1998
All persons 65 years and older are recommended to be immunised against influenza each autumn. As immunisation rates remain low, we conducted a randornised control trial in a three-partner urban general practice to evaluate the differential effectiveness of a single postcard reminder in a general practice setting compared to usual care. All nonresidential patients aged 65 years and over were identified from the agekeddisease register. After exclusions, 325 patients were stratified by sex (1 25 men and 200 women) and randomised to receive either a postcard reminder in large print mailed in April or usual care. General practitioners (GPs) were blind to the randomisation. A blinded record audit performed in July demonstrated that the postcard was effective in increasing immunisation for men (xzidI =3.85; ~0. 0 5) but not for women (xzidI=0.45; ~0. 5 0). After adjusting for 1995 irnmunisation status, the effect of the postcard on immunisation rates was even stronger in men (Wald ~~,~= 6. 2 0 ; p0.01) but remained non-significant in women (Wald xZid,=1 .38; ~0. 2 4). With this adjustment, the odds of having the 1996 flu vaccine for men sent the postcard reminder were three times that of men in the control group (OR=3.0; 95% CI 1.3-6.9). In a general practice setting, a single postcard reminder appears to be a promising way to boost influenza immunisation rates among ageing men. Replication of the study is recommended.
Randomized study of online vaccine reminders in adult primary care
Proceedings / AMIA ... Annual Symposium. AMIA Symposium
Online immunization reminders were implemented in an adult medicine setting in which all immunization history, vaccine ordering and charting were required online. Physicians were randomized to one of two arms in a cross-over design. Each arm was shown online recommendations for vaccines indicated by nationally accepted guidelines either during the first or during the second part of the study period The main purpose ofthe study was to assess the impact of reminders on correct decisions related to prescribing vaccines. Online reminders had thefollowing impact on physician behavior: 1)Physicians used the application almost 3 times as often when shown reminders. 2)Physicians in the reminder group were 27% less likely to order a vaccine in the reminder group (Pvalue 0.0005).
The effect of a combined influenza/pneumococcal immunization reminder letter
American Journal of Preventive Medicine, 2001
Background: The effect of a combined influenza and pneumococcal immunization reminder letter on increasing influenza and pneumoccocal immunization rates, and the timeliness of receiving immunizations after receipt of a reminder letter, have not been examined. This study addresses these issues using a sample of new Medicare beneficiaries residing in Hawaii. Methods: Newly enrolled Medicare beneficiaries in Hawaii from 25 September 1995 through 31 August 1996 were randomly assigned to one of three groups: Group 1, no letter (nϭ2144); Group 2, influenza immunization reminder letter only (nϭ2213); or Group 3, pneumococcal and influenza immunization reminder letter (nϭ2171). Health Care Financing Administration claims data were compared among groups. Results: In Group 3, the influenza immunization rate increased 3.8 percentage points (nϭ87; pϭ0.017) compared with Group 1. The Group 3 pneumococcal immunization rate increased 3.5 percentage points (nϭ78; pϽ0.001) compared to Group 1 and 4.0 percentage points (nϭ86; pϽ0.001) compared to Group 2. Sixty-six beneficiaries in Group 3 received simultaneous pneumococcal and influenza immunizations, a significant difference compared to Group 1 or Group 2. Increases in immunizations were observed immediately following the reminder letters and the effect persisted for 5 to 7 weeks. Conclusions: The combination letter increased both influenza and pneumococcal immunization rates and the simultaneous administration of immunizations without detrimental effect to influenza immunization rates. A combined reminder letter is inexpensive and recommended as part of a multicomponent campaign for adult immunization.
Vaccines
Objectives. We aimed to evaluate the effectiveness of a multifaceted procedure in improving pneumococcal and influenza vaccinations 6 months after an emergency department (ED) visit among patients aged 65 years and older. Methods. We conducted a cluster-randomized, controlled, parallel-group, open-label implementation trial in 18 EDs in France and Monaco. Participants were recruited from November 2015 to September 2016. EDs were randomly assigned with a 1:1 ratio to provide either a multifaceted procedure that combined structured information about pneumococcal and influenza vaccines and three text message reminders sent to patients every two weeks (intervention arm) or nonstructured information only (control arm). The outcomes were self-reported pneumococcal vaccination and influenza vaccination rates within 6 months of enrollment. Results. A total of 9 EDs were randomized to the intervention arm (n = 780 patients) and 9 to the control arm (n = 695 patients). The median age for all ...
The Journal of Primary Prevention, 2008
As part of the ''Provider and Patient Reminders in Ontario: Multistrategy Prevention Tools'' demonstration project, the purpose of this study was to explore the practice and physician characteristics associated with influenza vaccination rates following a reminder letter intervention for patients 65 years of age and older. Using a sample of 179 physicians, we estimated a multiple linear regression model to examine variables predictive of vaccination delivery rates. Several provider characteristics, including certification with the College of Family Physicians of Canada and practicing in an urban area, were predictive of the success of the reminder letter campaign. Examining other physician and practice factors associated with vaccination delivery following a reminder letter campaign may help improve such prevention efforts.
Impact of Appointment Reminders on Vaccination Coverage at an Urban Clinic
Pediatrics, 2000
Objective. To test if appointment reminders blinded to immunization status improve kept-appointment and vaccination coverage rates. Design. Controlled trial. Setting. Pediatric clinic serving a low-income community in New York City. Intervention. Children ages 4 through 18 months (n = 1273) scheduled sequentially for clinic appointments were systematically assigned to 1 of 4 study groups: control (n = 346); postcard (n= 314); telephone call (n = 307); and postcard and telephone call (n = 306). Outcome Measures. Kept-appointment and vaccination coverage rates. Results. Children assigned to the postcard and telephone group were 1.75 times more likely to keep their appointments than controls (95% confidence interval [CI] = 1.2, 2.5). Children who actually received the postcard and telephone reminders were 2.3 times more likely to keep an appointment than controls (95% CI = 1.4, 3.7). Children who kept appointments were 2.3 times more likely to be up-to-date with their immunizations (95...