Effectiveness of a Multifaceted Informational-Based and Text Message Reminders on Pneumococcal and Influenza Vaccinations in Hospital Emergency Departments: A Cluster-Randomized Controlled Trial.

Sarah Tubiana,Xavier Duval,Guillaume Der Sahakian,Didier Storme,Patrick Ray,Véronique Mattei,Pierre Michelet,Jeannot Schmidt,Fleur Jourda De Vaux,Pierre Hausfater,Christophe Choquet,Laure Jainsky,Jocelyn Raude,Olivier Gacia,Marie-Clément Kouka,Patrick Plaisance,J Levraut ,José Labarère ,Benoît Doumenc ,Yann-Érick Claessens

doi:10.3390/vaccines9090962

Abstract

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 enrolled patients was 74 years (25–75th percentiles, 69 to 82): 50.1% were male, 34.9% had at least one underlying condition, and 30.7% were at risk for invasive pneumococcal infection. In the intention-to-treat analysis, the multifaceted intervention did not alter the pneumococcal vaccination rate (6.4% versus 4.6%, absolute difference: 1.8; 95% CI: [−0.9 to 4.4]; p = 0.19), whereas it improved the influenza vaccination rate (52.1% versus 40.0%, absolute difference: 12.1; 95% CI: [2.4 to 21.8]; p = 0.01). At 12 months, mortality did not differ between the intervention (9.7%) and control (11.2%) arms (p = 0.35). Conclusions. A multifaceted intervention based on text message reminders provides an opportunity to increase anti-influenza vaccination among elderly patients visiting the ED. Efforts are warranted to provide better information on pneumococcal diseases and the benefits of pneumococcal vaccines, especially in the elderly.

Highlights

Community-acquired pneumonia and seasonal influenza are major causes of morbimortality worldwide, especially among the elderly and individuals with chronic underlying conditions
In this cluster-randomized, controlled, parallel-group, open-label, implementation trial, provision of information during emergency department (ED) visit followed by reminders through text messages did not alter 6-month pneumococcal vaccination but was associated with significant improvement in influenza vaccination rate among patients aged 65 years and older
All patients aged 65 years and older were eligible to participate, regardless of the reason for admission to ED, except those already vaccinated against S. pneumoniae

Summary

Introduction

Community-acquired pneumonia and seasonal influenza are major causes of morbimortality worldwide, especially among the elderly and individuals with chronic underlying conditions. Among the most promising interventions based on the COM-B model, those using external cues to action (i.e., circumstances that trigger the decision-making process leading to the uptake of the recommended vaccine, such as advice from a healthcare worker or illness of a friend/relative) seem to be generally effective to address vaccine hesitancy [11]. They include interventions using text messaging systems to promote vaccination in local healthcare facilities and training healthcare providers to improve their vaccine recommendations [12,13]

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Conclusion