Practice facilitation for family physicians to contact patients unvaccinated for COVID-19: a randomized trial

Context: Family physicians have an important role to play in encouraging vaccine confidence among their patients. We evaluated a practice facilitation intervention in partnership with Ontario Health, a provincial government agency, to support family physicians in Ontario with proactive outreach among patients unvaccinated for COVID-19.

Objective: To determine whether a multicomponent practice facilitation intervention would increase vaccine rates among patients of family physicians with the largest number of unvaccinated patients.

Study Design and Analysis: A 1:1 two-arm, pragmatic, cluster randomized controlled trial (Clinical trial#: NCT05099497).

Setting or Dataset: The trial was conducted from November 2021-March 2022 in Ontario, Canada’s most populous province. Data were obtained from the provincial vaccine registry and were linked to routinely used administrative databases.

Population Studied: 600 family physicians with the largest number of unvaccinated patients in the province.

Intervention/Instrument: Practice facilitators offered physicians support to identify, reach out, and counsel their unvaccinated patients.

Outcome Measures: Any vaccine dose during a four-month follow-up interval among rostered patients over 12 years/100.

Results: 300 family physicians who cared for a median of 2,399 patients (IQR 2,024-2,747) were randomized to control; the 300 randomized to the intervention cared for a median of 2,394 patients (IQR: 1,907-2,829). Only 29% (n=90) of intervention physicians accepted assistance from a practice facilitator. Among those that received support, 58% (n=51) used technical support to identify unvaccinated patients in their EMRs, 29% (n=26) connected with medical student volunteers to contact patients on their behalf, and 31% (n=27) used automated calling to reach patients.

The proportion of adult patients of control physicians with COVID vaccine doses was 82 (IQR: 78-85) at baseline and 83 (IQR: 80-86) after four months. In the intervention group, the proportion of patients with a COVID vaccine dose was 81 (IQR: 76-85) at baseline and 83 (IQR: 79-86) after four months. The relative rate of vaccine uptake of any dose was non-significant (RR= 1.0, CI:0.97-1.02, p=0.824).

Conclusion: There was no detectable increase in vaccination uptake among patients who were rostered to family physicians in the intervention group. Low intervention fidelity is a possible explanation for the trial’s null’s results.