Using patient portals to improve flu shot rates

Patient portals in electronic health records are a convenient way for patients and families to have useful information about diagnoses and prescriptions. The portal is also a useful tool for clinicians and families to communicate with each other. A study in Pediatrics looked at whether using the portal to remind parents about flu vaccines had a positive effect on vaccination coverage.1

The investigators conducted an intention-to-treat randomized clinical trial in children aged 6 months to <18 years seen in 1 of 53 primary care practices. Patients or their parent/proxy who were considered active portal users were randomly assigned to 1 of 2 groups: received reminder messages framed as gain or loss or received no messages. The participants were also individually randomized to receive a precommitment notice before the start of the flu season. The administration of ≥1 seasonal influenza vaccinations was considered the primary outcome measure. Of the patients aged 6 months to < 3 years who required a second dose of flu vaccine, participants were randomized to receive either a message to remind the parent of the second dose or not to receive a reminder.

22,046 children were included in the study. In the main control group, the vaccination rate was 56.9%. Within the intervention groups, the percentage was 58.0% in the group with memories of the loss frame (P = 0.07) and 58.0% in the group with the gain frame (P = 0.47). When we looked at the precommitment messages, the researchers found that the percentage was 58.3% in the precommitment group versus 57.0% in the control group (P = 0.11). Furthermore, the adjusted risk ratio for precommitment messages was 1.02 (95% CI: 1.00–1.04) versus control and 1.01 (95% CI: 0.98–1.05) for reminder frameworks and 1. 02 (95% confidence interval). [CI]: 1.00–1.04) for loss frame reminders. For the subgroup of children requiring a second dose, the second dose vaccination rates were 55.0% in the intervention group and 44.1% in the control group and had an adjusted risk ratio of 1.25 (95% CI: 1 .07-1.45).

The researchers concluded that using reminders from the flu vaccine patient portal did not affect the first dose of flu vaccination. However, using reminders proved to be an effective way to get young children back to the office for their second dose of the flu vaccine.


1. Lerner C, Albertin C, Casillas A, et al. Recollections of the patient portal for childhood influenza vaccinations: a randomized clinical trial. Pediatrics. July 28, 2021. Epub before press. doi:10.1542/peds.2020-048413

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