Clinic flu shot rates take a dive after daytime rush, study finds

Primary care clinics see a significant decline in influenza vaccinations as the day progresses, but "nudging" clinical staff to order vaccines may help curb this drop, a study published in JAMA Network Open found.

"As the day progresses, clinicians may have less time to spend on discussing the vaccine with patients," said lead study author Rebecca Kim, MD, resident physician in the primary care track at Philadelphia-based Penn Medicine. "Our findings show that time of day is an important factor in vaccination rates and could help to inform the design of future interventions to improve vaccination rates."

Looking at 11 primary care clinics in the University of Pennsylvania Health System from 2014 to 2017, the researchers found vaccination rates declined from 44 percent at 8 a.m. to 32 percent at 4 p.m.

In the third year of the study period, the team put a computerized nudge in the EHR at three of the clinics that prompted medical assistants to accept or decline an influenza vaccination order for eligible patients for clinicians to review.

The intervention was linked to a 9.5 percent increase in vaccinations — a nearly a 20 percent relative increase compared to practices without intervention, the researchers found.

Although vaccination rates improved with nudges, they still declined as the day continued, indicating the need for more strategies to address care variations by time of day, the researchers said.

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