RT Journal Article
SR Electronic
T1 Practice facilitation for family physicians to contact patients unvaccinated for COVID-19: a randomized trial
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 5454
DO 10.1370/afm.22.s1.5454
VO 21
IS Supplement 3
A1 Shuldiner, Jennifer
A1 Lofters, Aisha
A1 Shah, Noor-Ul-Huda
A1 Kiran, Tara
A1 Bar-Ziv, Stacey
A1 Bogoch, Isaac
A1 Presseau, Justin
A1 Nowak, Dominik
A1 Ivers, Noah
YR 2023
UL http://www.annfammed.org/content/21/Supplement_3/5454.abstract
AB 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.