By Alison McCook
National Harbor, Md.—Simple phone calls help remind patients to get the second dose of a vaccine against shingles, according to new research presented at the AMCP Nexus 2019 annual meeting.
In the study (poster Z4), researchers from Blue Cross Blue Shield of Michigan found that members who spoke to a pharmacy intern who called with a reminder were more likely to get their second dose of recombinant zoster vaccine (RZV) (Shingrix, GlaxoSmithKline), and during the recommended time frame, than patients who did not speak to an intern.
“It was kind of a good surprise that the phone calls improved adherence rates among our members,” study author Hiba Alzouby, a pharmacy clinical services intern at Blue Cross Blue Shield of Michigan, told Pharmacy Practice News. “It gave me hope.”
The calls are necessary, she explained, because until recently patients only needed one dose of a vaccine against shingles. In 2018, the U.S. Centers for Disease Control and Prevention recommended Shingrix, a two-dose version of the vaccine, as the preferred agent, instead of the single-dose option, zoster vaccine live (Zostavax, Merck) (MMWR Morb Mortal Wkly Rep 2018;67:103–108). However, it’s all too easy for patients to miss the second dose, Ms. Alzouby said: “I would probably forget, honestly.”
Indeed, in May 2018, the CDC reported that some providers had confused the two vaccines, and had given patients instructions for Zostavax and did not instruct them to return for a second dose (MMWR Morb Mortal Wkly Rep 2018;67:585-586).
To help ensure members were getting the full effectiveness of the Shingrix vaccine, Blue Cross Blue Shield of Michigan decided to make phone calls to remind them about the second dose. The calls took place over approximately one month during the summer of 2018, during which time Shingrix was in a shortage—further raising the insurer’s concerns that patients would miss their second dose, Ms. Alzouby said. “We were asking members to really be proactive in getting that second shot.”
Approximately seven interns called more than 1,000 members as they approached the period when they should receive their second dose, and spoke with 336 (31%). Ms. Alzouby and her colleagues then compared outcomes between patients they spoke with and those of 754 members who got the first Shingrix shot and were on the call list but didn’t speak to an intern; in some cases, interns left a voicemail.
The researchers found that 92.6% of patients who spoke with a pharmacy intern went on to get their second RZV dose versus 87.1% of those who had no contact (P=0.01). Looking at the timing of the dose, patients who spoke with an intern were significantly more likely to get their second shot within the recommended 60 to 180 days (P=0.002).
Phone calls may work better than letters and other more passive reminders, Ms. Alzouby said, because patients can’t toss a phone call in the trash without looking at it; furthermore, a one-on-one with a pharmacy intern gives patients an opportunity to clear up any confusion. “If a patient doesn’t have great health literacy, they may not even remember they got a Shingrix vaccine,” she said.
Although the initiative did take up interns’ time, the calls did not require 100% of their time, so they were able to maintain other projects, Ms. Alzouby noted. Besides insurers, anyone who administers the first RZV dose—typically a pharmacy or doctor’s office—would be a natural candidate to remind patients to get their second dose, she explained. “Those facilities are really suited to reach out to the patient and tell them, ‘This is a good time for you to come back.’”
Health plans, doctors’ offices and pharmacies are well positioned to try a similar initiative, said Casey Tak, PhD, MPH, an assistant professor in the Division of Pharmaceutical Outcomes and Policy at the UNC Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill. “I think any or a combination of these stakeholders could make efforts to improve vaccination rates.”
Dr. Tak cautioned, however, that offices considering making calls to patients should think about whether the effort will be worth the outcome, given that this study of more than 1,000 outreaches yielded only a 5.5% difference in the second dose completion rate (since 92.6% of patients who spoke with a pharmacy intern got their second RZV dose versus 87.1% of those who didn’t get the phone call).
“Although improving vaccination rates remains a priority, the opportunity cost of making the phone calls needs to be considered,” said Dr. Tak, who did not participate in the study.
Despite this caveat, Dr. Tak noted this type of initiative may make a difference with other vaccines that are given in a series, such as pneumococcal vaccinations, for which follow-up administration rates remain stubbornly low. Indeed, Ms. Alzouby noted that many other vaccines, such as those against varicella and hepatitis A and B, are administered in a series, which previous research has shown many patients fail to complete (Am J Public Health 2009;99[suppl 2]:S389-S397).
Dr. Tak agreed that some kind of reminder aid is needed for vaccinations that have proven to present compliance challenges. “In addition to the yearly flu vaccine,” he said, “reminder calls for pneumococcal vaccination among older adults may be helpful, if it is shown to improve rates of completion.”
The sources reported no relevant financial relationships. The study was sponsored by Blue Cross Blue Shield of Michigan.