‘We were a bit surprised’: Asking patients in ED about flu shot improves uptake

Key takeaways:

• Among those who were part of a messaging intervention in the ED, 30-day influenza vaccine uptake was 41%.
• The findings have significant implications for populations without access to primary care.

Use of an influenza vaccine messaging platform in EDs increased vaccine uptake among unvaccinated patients, a study in NEJM Evidence showed.

“We fully expected the interventions to improve vaccination rates... but we were a bit surprised at how large a difference there was,” Robert M. Rodriguez, MD, a professor of emergency medicine at the University of California, San Francisco School of Medicine, told Healio.

According to Rodriguez, one of the driving factors of the study was that the patient populations that the researchers serve — such as homeless and historically underrepresented populations — “really don’t get opportunities to get vaccinated for various diseases that other people who have insurance and other access to health care do.”

In the randomized controlled trial, Rodriguez and colleagues created an influenza vaccine messaging platform that consisted of a 3-minute video, one-page flier and a verbal scripted health care provider message.

Participants were then asked, “would you accept the influenza vaccine in the ED today if your doctor asked you to get it?” If participants answered “yes” and gave permission, their health care providers were notified.

The video and flier also featured physicians and personnel who matched the racial and ethnic characteristics of the participant.

Participants (n = 767) were assigned to either:

• intervention M, which included the video, flier and scripted message, followed by the vaccine acceptance question and provider notification;
• intervention Q, which included no messaging but the vaccine acceptance question and provider notification; or
• a control group, which included usual care and no interventions.

The trial was conducted across six ED departments in five U.S. cities from October 2022 through February 2023.

Among those in the cohort, 32% lacked primary care, 9% were homeless or marginally housed, 16% lacked health insurance and 36% were Black.

The researchers found that the intervention M, intervention Q and control groups had 30-day vaccine uptakes of 41%, 32% and 15%, respectively.

When intervention M was compared with intervention Q, the adjusted difference in 30-day vaccine uptake was 8.7% (95% CI, –0.1% to 17.6%).

Intervention M (49%) and intervention Q (45%) both had similar percentages of those who said they would accept the influenza vaccine in the ED (adjusted difference = 3.1%; 95% CI, –5.9% to 12.1%).

“There’s always going to be a population that does not have access to primary care, that has no other place to go and does not have access to or receive messaging about vaccines,” Rodriguez explained. “The practical implications of this are that we should engage these populations in the ED, provide messaging for flu vaccines and offer them in the ED.”

He added that the next steps for future research could include “expanding on the programs like we enacted, and implementation-type science — in other words, making it easier to do in a variety of ED settings.”

“We had specific staff and personnel in our EDs that allowed us to provide messaging and so forth. Other EDs ... they’re not going to have that dedicated staff,” Rodriguez noted. “The next step is making it widely available through a number of ways.”

References:

• Just ask: patients in the ER are willing to get a flu shot. https://www.eurekalert.org/news-releases/1038816. Published March 26, 2024. Accessed March 26, 2024.
• Rodriguez R, et al. NEJM Evid. 2024;doi:10.1056/EVIDoa2300197.