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Abstract

Purpose:

To assess the effectiveness of an intervention to promote influenza vaccination among members of an Affordable Care Act (ACA) insurance plan.

Design:

Randomized controlled trial.

Setting:

Messages were delivered by a community-based, nonprofit health insurance provider to its members in Central Texas.

Participants:

Adult subscribers for whom either a phone number or an e-mail address was available (n = 25 649).

Intervention:

Participants were randomly assigned to be sent (1) no messages, (2) messages encouraging influenza vaccination via e-mails and texts, and (3) messages encouraging influenza vaccination through e-mails, texts, and postal mail. Messages were sent between September 12, 2017 and November 17, 2017.

Measures:

Influenza vaccination was determined using medical and pharmacy claims.

Analysis:

Rate differences and 95% confidence intervals between each exposure condition were calculated for the overall population and by subgroups.

Results:

The vaccination rate by December 31, 2017 was 16.9%. Those sent both electronic messages and postal mail were significantly more likely to be vaccinated than those who were not sent messages (rate difference: 2.5%; 95% confidence interval [CI]: 1.4-3.6) and those who were sent electronic messages only (rate difference: 1.6%; 95% CI: 0.5-2.8).

Conclusion:

A combination of messages delivered via text, e-mail, and postal mail generated a modest but significant positive effect on influenza vaccine rates in an ACA plan population. The postal mail component was essential for achieving this effect.

Keywords

Patient Protection and Affordable Care Act influenza vaccines reminder systems not-for-profit insurance plans health promotion

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References

Centers for Disease Control and Prevention. Flu Vaccination Coverage, United States, 2016-17 Influenza Season. 2017; https://www.cdc.gov/flu/fluvaxview/coverage-1617estimates.htm. Accessed December 31, 2018.

Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives. Accessed December 31, 2018.

Community Preventive Services Task Force. Task Force Findings for Increasing Vaccination. 2010. https://www.thecommunityguide.org/content/task-force-findings-increasing-vaccination. Accessed December 31, 2018.

Community Preventive Services Task Force. Task Force Finding and Rationale Statement: Increasing Appropriate Vaccination: Client Reminder and Recall Systems. 2015. https://www.thecommunityguide.org/sites/default/files/assets/Vaccination-Client-Reminders.pdf. Accessed December 31, 2018.

US Centers for Medicare and Medicaid Services. Preventive care for adults. https://www.healthcare.gov/preventive-care-adults/. Accessed December 31, 2018.

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Supplementary Material

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