Mailing a Letter to Increase Vaccination Rates?


Respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), affect more than 30 million American adults.

Respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), affect more than 30 million American adults. Pharmacists know only too well that these conditions increase patients' risk of emergency department visits, absences at work and school, and death. In addition, patients who have either of these pulmonary diseases are at elevated risk for poor outcome if they contract influenza or pneumococcal disease.

Researchers from the University of Kansas School of Pharmacy have published a study that examines pharmacist-initiated interventions that increase the likelihood that patients with asthma or COPD receive a flu vaccine. Published in the Journal of Community Health, the researchers showed that using an old-fashioned intervention— a standard mailed letter— may help improve vaccination rates.

In this study, the researchers compared phone calls, letters, and no intervention in a group of adults who had either asthma or COPD. Participants' mean age was around 55, and the majority of patients were female.

Patients who received a standard letter were significantly more likely to receive an influenza vaccination than those who received a phone call. Among the 49 patients younger than age 65 who received letters, 41 came in for flu vaccinations and 30 also received the pneumococcal vaccine. Among the 14 patients older than age 65 who received a letter, all came in for influenza vaccine and 9 received the pneumococcal vaccine.

In comparison, among 50 patients younger than age 65 who received a phone call, 31 received influenza vaccine and 21 received pneumococcal vaccine. Among 27 who were older than 65, 25 received both influenza and pneumococcal vaccines.

This is not the first study to find that mailed the letters result in higher rates of immunization. Other studies have shown higher rates of immunization with a mailed letter and have also found that patients who receive letters are more likely to attend preventive care appointments. The authors noted that letters are physical reminders that are readily assessable weeks or months after the intervention.


Klassing HM, Ruisinger JF, Prohaska ES, et al. Evaluation of pharmacist-initiated interventions on vaccination rates in patients with asthma or COPD. J Community Health. 2017 Aug 29. doi: 10.1007/s10900-017-0421-9. [Epub ahead of print]

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