Physician Messages Increased COVID-19 Vaccination Among Black and Latino Seniors – NCAL Research Spotlight

Kaiser Permanente clinical trial compared methods for reaching at-risk populations

By Jan Greene

Black and Latino seniors were more likely to get the COVID-19 vaccine after receiving an email or letter from their Kaiser Permanente doctor, new research shows.

The report about the randomized clinical trial was published June 17 in JAMA Network Open.

“As the COVID-19 pandemic continues, vaccination remains the main way for older people to protect themselves. This study provides vital information on how to reach unvaccinated older adults in at-risk communities,” said the study’s lead author. Yi-Fen Irene Chen, MDassociate general manager of The Permanent Medical Group.

Yi-Fen (Irene) Chen, MD, Associate Executive Director, The Permanente Medical Group.

“The randomized controlled trial design of this study makes these results particularly compelling. We were able to directly compare the effectiveness of different forms of outreach,” the lead author explained. Tracy Lieu, MD, MPHdirector of Kaiser Permanente Research Division.

The study included 8,287 patients from Kaiser Permanente Northern California who had not been vaccinated as of March 2021 and lived in 4 communities: Central Valley, Fresno, South Sacramento and San Jose. They were randomly assigned to 3 groups: 2,767 received culturally appropriate messages about vaccination, 2,747 received standard messages, and 2,773 received no special messages beyond the usual communication about vaccination. vaccination against COVID-19.

All those in the 2 intervention groups received a vaccination message sent on behalf of their primary care physician: either an email via the Kaiser Permanente online portal, or a letter by post if they were not registered to use the portal. Messages were in Spanish for those whose records indicated they preferred it.

Tracy Lieu, MD, MPH, director of the Research Division.

The emails and letters discussed confidence in vaccines, their safety and effectiveness, side effects and how to book an appointment for a vaccine. Those culturally relevant to Black and Latino communities also addressed issues such as cost (vaccine is free), immigration status (vaccination is available to all and personal information is not shared with outside agencies) and racial and ethnic disparities in COVID-19 (Black/African American and Latino communities have been most affected by the pandemic).

Four weeks later, members of the 2 intervention groups who had not yet been vaccinated received a postcard containing information about the vaccine, a QR code, a website and a telephone number for booking. Those in the culturally appropriate group received postcards with pictures of older adults from their racial or ethnic group.

Both intervention groups were more likely to get vaccinated after receiving the emails, letters and postcards, compared to the group that did not receive special communications. Eight weeks into the program, vaccination rates were 24% in the culturally appropriate group and 23% in the standard outreach group, compared to the usual care group which was 21.7%. The difference between the 2 intervention groups was not statistically significant.

Send a compelling message

The study authors noted that if this 2.3% higher vaccination rate found in this study had been applied to all unvaccinated black and Latino seniors in the United States, an additional 238,000 people could have been vaccinated.

The difference in vaccination rates was modest but larger than seen in previous vaccination awareness studies, the authors said. “This suggests that doctors are key influencers with their patients, and outreach on behalf of the doctor may be particularly effective with black and Latino adults, who tend to have higher rates of COVID-19 vaccine hesitancy. “, said Debora Sawyer, MDobstetrician-gynecologist from Groupe Médical Permanente (TPMG) and its medical director for ambulatory quality.

As COVID-19 vaccines were rolled out in early 2021, TPMG clinical officials were concerned about the potential for vaccine hesitancy to limit the reach of vaccines in at-risk communities, said Silvia Teran, MD, a TPMG physician who serves as Medical Director for TPMG Health Engagement Consulting Services. “The impending storm clouds were quite visible and we could see there was a disparity in vaccine acceptance,” she said. “Surveys have also shown that primary care physicians have a high level of trust, so we wanted to leverage that in our messaging, by having it come from their physicians.”

The medical group’s patient engagement specialists searched for survey data and found particular hesitation among older black and Latino adults, who had specific concerns about the cost of vaccination and information sharing. personal with the government, such as immigration status. So those topics were covered in the culture-appropriate versions of communications, explained Patricia Escobar, MPH, consultant at TPMG Health Engagement Consulting Services.

“We started by emailing everyone in the outreach groups, which is inexpensive but excludes people who don’t use our secure online messaging system,” Escobar said. “That’s where letters and postcards come in the mail, and we’ve included a QR code to make it easy to access vaccination information using their phones.”

Teran noted the importance of working harder to reach people who don’t use technology. “There’s always that small number that we can’t overlook, and often it’s a high-risk population that’s older and has more disease,” she said.

The language was designed to be encouraging but not prescriptive. A version of the postcard states: “We have received the COVID-19 vaccine! Have you?” “It’s important to keep messaging simple and straightforward,” Teran said.

More intensive interventions could increase vaccination rates even more than these kinds of targeted messages, the authors said. These include real-time conversations, community outreach, and behavioral nudges, which are small suggestions meant to initiate behavior change, like putting healthy food at your fingertips.

The research was supported by a grant from the Permanente Medical Group’s Applied Research and Delivery Science Program.

Other co-authors were Nicola Klein, MD, Ph.D.Eric P. Elkin, MPH, Cimone Durojaiye, MPH, Stephanie Prausnitz, MS, and Charles P. Quesenberry, PhDthe Research Division; Nancy Goler, MDand Stephen M. Parodi, MD, of the Groupe Médical Permanente; and Lucy Finn, MPH, of TPMG Consulting Services.

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About the Kaiser Permanente Research Division

Kaiser Permanente’s Research Division conducts, publishes and disseminates epidemiology and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of disease and well-being and to improve the quality and cost-effectiveness of health care. Currently, more than 600 DOR employees are working on more than 450 epidemiological and health services research projects. For more information, visit or follow us @KPDOR.

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