TY - JOUR
T1 - Clinical Outcomes With Electronic Nudges to Increase Influenza Vaccination
T2 - A Prespecified Analysis of a Nationwide, Pragmatic, Registry-Based, Randomized Implementation Trial
AU - Johansen, Niklas Dyrby
AU - Vaduganathan, Muthiah
AU - Bhatt, Ankeet S
AU - Lee, Simin Gharib
AU - Modin, Daniel
AU - Claggett, Brian L
AU - Dueger, Erica L
AU - Samson, Sandrine
AU - Loiacono, Matthew M
AU - Harris, Rebecca C
AU - Køber, Lars
AU - Solomon, Scott D
AU - Sivapalan, Pradeesh
AU - Jensen, Jens Ulrik Stæhr
AU - Martel, Cyril Jean-Marie
AU - Krause, Tyra Grove
AU - Biering-Sørensen, Tor
PY - 2024/4
Y1 - 2024/4
N2 - BACKGROUND: In the NUDGE-FLU (Nationwide Utilization of Danish Government Electronic letter system for increasing inFLUenza vaccine uptake) trial, electronic letters incorporating cardiovascular (CV) gain-framing and repeated messaging increased influenza vaccination by approximately 1 percentage point.OBJECTIVE: To evaluate the effects of the successful nudging interventions on downstream clinical outcomes.DESIGN: Prespecified exploratory analysis of a nationwide randomized implementation trial. (ClinicalTrials.gov: NCT05542004).SETTING: The 2022 to 2023 influenza season.PARTICIPANTS: 964 870 Danish citizens aged 65 years or older.INTERVENTION: Usual care or 9 different electronically delivered behavioral nudging letters.MEASUREMENTS: Cardiovascular, respiratory, and other clinical end points during follow-up from intervention delivery (16 September 2022) through 31 May 2023.RESULTS: The analysis set included 691 820 participants. Hospitalization for pneumonia or influenza occurred in 3354 of 346 327 (1.0%) participants in the usual care group, 396 of 38 586 (1.0%) in the CV gain-framing group (hazard ratio [HR], 1.06 [95% CI, 0.95 to 1.18]; versus usual care), and 403 of 38 231 (1.1%) in the repeated letter group (HR, 1.09 [CI, 0.98 to 1.21]; versus usual care). In the usual care group, 44 682 (12.9%) participants were hospitalized for any cause, compared with 5002 (13.0%) in the CV gain-framing group (HR, 1.00 [CI, 0.97 to 1.03]; versus usual care) and 4965 (13.0%) in the repeated letter group (HR, 1.01 [CI, 0.98 to 1.04]; versus usual care). A total of 6341 (1.8%) participants died in the usual care group, compared with 721 (1.9%) in the CV gain-framing group (HR, 1.02 [CI, 0.94 to 1.10]; versus usual care) and 646 (1.7%) in the repeated letter group (HR, 0.92 [CI, 0.85 to 1.00]; versus usual care).LIMITATION: Prespecified but exploratory analysis, potential misclassification of events in routinely collected registry data, and results may not be generalizable to other health systems or countries with other racial compositions and/or cultural or societal norms.CONCLUSION: In a prespecified exploratory analysis, modest increases in influenza vaccination rates seen with electronic nudges did not translate into observable improvements in clinical outcomes. Seasonal influenza vaccination should remain strongly recommended.PRIMARY FUNDING SOURCE: Sanofi.
AB - BACKGROUND: In the NUDGE-FLU (Nationwide Utilization of Danish Government Electronic letter system for increasing inFLUenza vaccine uptake) trial, electronic letters incorporating cardiovascular (CV) gain-framing and repeated messaging increased influenza vaccination by approximately 1 percentage point.OBJECTIVE: To evaluate the effects of the successful nudging interventions on downstream clinical outcomes.DESIGN: Prespecified exploratory analysis of a nationwide randomized implementation trial. (ClinicalTrials.gov: NCT05542004).SETTING: The 2022 to 2023 influenza season.PARTICIPANTS: 964 870 Danish citizens aged 65 years or older.INTERVENTION: Usual care or 9 different electronically delivered behavioral nudging letters.MEASUREMENTS: Cardiovascular, respiratory, and other clinical end points during follow-up from intervention delivery (16 September 2022) through 31 May 2023.RESULTS: The analysis set included 691 820 participants. Hospitalization for pneumonia or influenza occurred in 3354 of 346 327 (1.0%) participants in the usual care group, 396 of 38 586 (1.0%) in the CV gain-framing group (hazard ratio [HR], 1.06 [95% CI, 0.95 to 1.18]; versus usual care), and 403 of 38 231 (1.1%) in the repeated letter group (HR, 1.09 [CI, 0.98 to 1.21]; versus usual care). In the usual care group, 44 682 (12.9%) participants were hospitalized for any cause, compared with 5002 (13.0%) in the CV gain-framing group (HR, 1.00 [CI, 0.97 to 1.03]; versus usual care) and 4965 (13.0%) in the repeated letter group (HR, 1.01 [CI, 0.98 to 1.04]; versus usual care). A total of 6341 (1.8%) participants died in the usual care group, compared with 721 (1.9%) in the CV gain-framing group (HR, 1.02 [CI, 0.94 to 1.10]; versus usual care) and 646 (1.7%) in the repeated letter group (HR, 0.92 [CI, 0.85 to 1.00]; versus usual care).LIMITATION: Prespecified but exploratory analysis, potential misclassification of events in routinely collected registry data, and results may not be generalizable to other health systems or countries with other racial compositions and/or cultural or societal norms.CONCLUSION: In a prespecified exploratory analysis, modest increases in influenza vaccination rates seen with electronic nudges did not translate into observable improvements in clinical outcomes. Seasonal influenza vaccination should remain strongly recommended.PRIMARY FUNDING SOURCE: Sanofi.
UR - http://www.scopus.com/inward/record.url?scp=85190900279&partnerID=8YFLogxK
U2 - 10.7326/M23-2638
DO - 10.7326/M23-2638
M3 - Journal article
C2 - 38498876
SN - 0003-4819
VL - 177
SP - 476
EP - 483
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 4
ER -