Patient Views on Reminder Letters for Influenza Vaccinations in an Older Primary Care Patient Population: A Mixed Methods Study
Anderson, Kelly K., Sebaldt, Rolf J., Lohfeld, Lynne, Karwalajtys, Tina, Ismaila, Afisi S., Goeree, Ron, Donald, Faith C., Burgess, Ken, Kaczorowski, Janusz, Canadian Journal of Public Health
Objectives: To explore the perspectives of older adults on the acceptability of reminder letters for influenza vaccinations.
Methods: We randomly selected 23 family physicians from each Family Health and Primary Care network participating in a demonstration project designed to increase the delivery of preventive services in Ontario. From the roster of each physician, we surveyed 35 randomly selected patients over 65 years of age who recently received a reminder letter regarding influenza vaccinations from their physician. The questionnaires sought patient perspectives on the acceptability and usefulness of the letter. We also conducted follow-up telephone interviews with a subgroup of respondents to explore some of the survey findings in greater depth.
Results: 85.3% (663/767) of patients completed the questionnaire. Sixty-five percent of respondents recalled receiving the reminder (n=431), and of those, 77.3% found it helpful. Of the respondents who recalled the letter and received a flu shot (n=348), 11.2% indicated they might not have done so without the letter. The majority of respondents reported that they would like to continue receiving reminder letters for influenza vaccinations (63.0%) and other preventive services (77.1%) from their family physician. The interview participants endorsed the use of reminder letters for improving vaccination coverage in older adults, but did not feel that the strategy was required for them personally.
Conclusions: The general attitude of older adults towards reminder letters was favourable, and the reminders appear to have contributed to a modest increase in influenza vaccination rates.
Key words: Reminder systems; preventive health services; influenza vaccine; patient satisfaction
There is substantial evidence supporting patient reminders as an effective tool for increasing influenza vaccination rates in older adult populations. a systematic review found that all types of patient reminders, including letters, improved the uptake of influenza immunizations.1 Reminders are more effective with increased frequency and degree of personalization2 and with the inclusion of educational materials.3
Few studies have examined patient perspectives on reminders. Survey findings suggest that older patients are more likely to find a reminder helpful,4 and that a letter from a physician is the primary factor influencing many individuals' vaccination decisions. 5 patients also report preferring that their primary care providers take a more proactive approach to influenza vaccination. 6 eliciting patient feedback on reminder systems for preventive services can help ensure that features important to patients are included, potentially improving compliance with the recommendations.7
As part of the Provider and Patient Reminders in Ontario: Multi-strategy Prevention Tools (p-pROMpt) project, an influenza vaccination reminder letter intervention was implemented for older adults in primary care network (pcn) and Family health network (Fhn) practices across southwestern Ontario. These health care delivery models are characterized by patient rostering, a capitation payment structure, and financial incentives to physicians for providing targeted preventive services.8
The purpose of this mixed methods study was to examine patient views on reminder letters for influenza vaccinations. We used a questionnaire to gather information on the acceptability and utility of the reminder letters, followed by qualitative interviews to explore the survey findings in greater depth.
We used a sequential explanatory mixed methods design, which involves qualitative data collection and analysis subsequent to quantitative data collection and analysis.9,10 ethics approval was obtained from the McMaster university Research ethics board.
We used multistage cluster sampling to randomly select participants. …