Impact of patient and provider nudges on addressing herpes zoster vaccine series completion

Justin Gatwood; Andrea Brookhart; Olivia Kinney; Tracy Hagemann; Chi-Yang Chiu; Sujith Ramachandran; Emily Gravlee; Kenneth Hohmeier

doi:10.1016/j.vaccine.2022.12.016

Impact of patient and provider nudges on addressing herpes zoster vaccine series completion

Vaccine. 2023 Jan 16;41(3):778-786. doi: 10.1016/j.vaccine.2022.12.016. Epub 2022 Dec 14.

Authors

Justin Gatwood¹, Andrea Brookhart², Olivia Kinney², Tracy Hagemann³, Chi-Yang Chiu⁴, Sujith Ramachandran⁵, Emily Gravlee⁵, Kenneth Hohmeier³

Affiliations

¹ University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Drive, Nashville, TN 37211, USA. Electronic address: jgatwood@uthsc.edu.
² Kroger Health, 555 Race Street, Cincinnati, OH 45202, USA.
³ University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Drive, Nashville, TN 37211, USA.
⁴ University of Tennessee Health Science Center, College of Medicine, Doctor's Office Building, Memphis, TN 38163, USA.
⁵ University of Mississippi, School of Pharmacy, P.O. Box 1848, Oxford, MS 38677, USA.

PMID: 36526504
DOI: 10.1016/j.vaccine.2022.12.016

Abstract

Objectives: To determine the combined impact of provider-facing and text message-based, patient nudges on herpes zoster vaccine series completion.

Methods: Following a period during which Kroger Health implemented provider facing nudges, select US patients that initiated herpes zoster vaccination were randomized to receive timed text messages when the second dose was due and available as part of a quality improvement exercise. Main comparisons were between patients intervened by provider nudge only and those intervened by both provider and patient nudges. Data were assessed by GEE-basedlogistic and linear regression, controlling for available patient- and store-level characteristics, and geospatial analyses.

Results: During the baseline period, 100,627 adults received at least one HZ vaccine dose and 83.9% completed the series within 6 months over 88.6 days (SD: 26.53) on average. In the intervention period, 120,339 adults were vaccinated at least once and series completion was 88.3% (both provider nudges and text messaging) and 85.3% (not texted) during this observation window (both p < 0.0001). Time between doses was shorter for those who received text messages compared to both the baseline period and those in the intervention period that were not texted (both p < 0.001). Controlling for multiple characteristics, the odds of completion improved in the intervention period compared to baseline (OR: 1.07; 95% CI: 1.033-1.111), but a noticeably higher completion odds was observed amongst patients who received a text message in the intervention period (OR: 1.35; 95% CI: 1.286-1.414). Adjusting for patient and pharmacy factors, those who were texted received their second herpes zoster vaccine dose 8.6 days sooner (95% CI: -9.08 - -8.17, p < 0.0001) compared to those intervened by the provider nudge only.

Conclusion: The combined use of clinical and patient-focused nudges is a simple mechanism by which pharmacies and other health care access points can address the multi-dose vaccine needs of diverse patient populations.

Keywords: Adult vaccination; Clinical decision support; Community pharmacy; mHealth.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Community Pharmacy Services*
Health Services Accessibility
Herpes Zoster Vaccine*
Herpes Zoster* / prevention & control
Humans
Pharmacies*
Vaccination

Substances

Herpes Zoster Vaccine