Increasing influenza and pneumococcal vaccination in Australian general practice using automatic SMS and printed patient reminders: a non-randomised feasibility study

Problem

The Problem:The Australian Immunisation Handbook recommends that at-risk adult patients* should receive influenza and/or pneumococcal (Prevenar13) vaccines. However, vaccination rates among those at risk and aged <65 years (or <70 year for Prevenar13) is very low. Knowledge about eligibility and cost may be factors that influence uptake.The question:Do automatic patient reminders (SMS and printed) increase vaccination coverage. * PATIENTS AT RISK: Those with cardiovascular, neurological, respiratory or haematological conditions, chronic kidney disease, diabetes mellitus or other metabolic conditions, rheumatoid or psoriatic arthritis, ulcerative colitis, Crohn's disease, with haematological malignancies, or immunocompromised

Approach

16 participating intervention clinics had 66,999 active patients aged 18-69 years, with 29% of them (n=19,230) considered at risk and eligible because of their health condition. A total of 14,400 SMS reminders were sent to eligible patients in 2021 across all practices. Of those at risk and aged 18-69 years, 37% attended a participating GP and been sent at least one SMS reminder.

Findings

Outcomes:INFLUENZA: In 2020, 33% of patients at risk and aged 18-64 years received the influenza vaccine. In 2021, overall, influenza vaccination among patients who had not been sent any reminder was 17.6% (95%CI 17.0-18.2) compared to 44.2% (95%CI 42.4-45.9) among those sent SMS reminders (p<0.001). Influenza vaccination coverage increased with the number of SMS reminders sent, going from 39.4% (95% CI 37.3-41.5) among those sent only 1 SMS, to 50.3% among those sent 2 SMS (95% CI 46.8-53.8) and 59.8% (95% CI 54.4-65.3) among those sent 3 or more reminders (p-value for trend <0.001).PNEUMOCOCCAL: By March 2021, only 0.4% of patients at risk and aged 18-69 years had received Prevenar13. By October 2021, overall, 7.8% (95%CI 6.9-8.6) of at-risk patients sent SMS reminders had received Prevenar13, compared to only 1.3% (95%CI 1.1-1.5) of patients at risk who had not been sent a reminder (p<0.001) Prevenar13 vaccination coverage increased with the number of SMS reminders sent, going from 5.3% (95% CI 4.3-6.5) among those sent only 1 SMS, to 8.2% among those sent 2 SMS (95% CI 6.4-10.6) and 10.3% (95% CI 7.4-14.4) among those sent 3 or more reminders (p-value for trend <0.001).

Consequences

Take home message for practices:SMS reminders represent a low-cost and effective intervention to increase influenza and pneumococcal vaccination among patients at risk in Australian general practice.SMS reminders kept influenza vaccination rates at higher levels among patients at risk, despite the lower influenza vaccination uptake observed in 2021 because of COVID-19 restrictions.Despite barriers to pneumococcal vaccination such as cost and changing guidelines, SMS reminders increase Prevenar13 vaccination coverage, with patients who receive more reminders showing a greater vaccination coverage.