Jennifer Shuldiner, Huda Shah, Jeremy Grimshaw, Monica Taljaard, Laura Desveaux, Justin Presseau, Mina Tadrous, Tara Kiran, Micheal Green, Isaac Bogoch, Holly Witteman, Aisha Lofters, Noah Ivers
Institution of primary author:
Womens College Hospital
One way to build vaccine confidence and uptake is through advice from a trusted health professional. In particular, family physicians may be able to leverage existing relationships to increase vaccinations. We have developed an intervention in collaboration with Ontario Health, targeting physicians in Ontario with the largest number of unvaccinated patients. Through practice facilitation we offered them support to help them identify and counsel their unvaccinated patients. We are evaluating this program to understand whether, how, and why it affected vaccine uptake and to explore how targeted assistance to physicians can be adapted and scaled for other clinical areas of primary care.
We are conducting a randomized trial with an embedded process evaluation to explore how and why this intervention may or may not have worked, all informed by the RE-AIM framework. We used provincial vaccine registry data and linked administrative databases to identify and randomize the 600 family physicians with the largest number of unvaccinated patients. Trial outcomes (vaccine uptake) will be measured using the same data after 4 months. An embedded process evaluation through interviews with those who do and do not engage with the intervention will assess intervention fidelity and examine mechanisms of action.
As the intervention is ongoing, we present a project update and preliminary findings. Of the 300 physicians randomized to the intervention, 20% (59) declined, were unreachable or closed their practice, and 80% (240) accepted support or asked for a follow-up conversation within 2 months. Among those who received help, most opted for support that required minimal clinical resources, with 13% (30) receiving technical help to identify unvaccinated patients, 11% (26) requesting medical student volunteers to contact patients on their behalf and 6% (14) opting for an automated calling system to reach patients. Other supports that were requested include: communication scripts for administrative staff (6%,14), resources for physicians on vaccine information (3%, 6), and email templates to send to patients (6%, 14). Common barriers identified by practice facilitators include the inability to reach the physician, the incapacity of the physician or their staff to take on additional tasks, and challenges with engagement (e.g., lack of interest and trust).
Strategies to help support family physicians regarding vaccine rollout or other primary care areas should address the scarcity of time and resources of physicians, challenges in contacting the physician, and the process of building trust and relationships required to provide support.
CLINICALTRIALS REGISTRATION: NCT05099497Jennifer Shuldiner poster