Practice facilitation to support primary care physicians with COVID-19 vaccine uptake: A randomized clinical trial

Importance — Recommendations by family physicians are associated with uptake of vaccines, but many family physicians had limited capacity to identify patients in their practice who might benefit from personalized vaccination counselling. Practice facilitation is an evidence-based method of supporting changes in primary care, but its role in supporting COVID-19 vaccination rates is unknown.

Objective —To determine whether a multicomponent practice facilitation intervention would increase COVID-19 vaccine rates in the practices of family physicians with the largest number of unvaccinated patients.

Design, Setting, and Participants — This 2-arm cluster-randomized clinical trial was conducted from November 15, 2021, to March 15, 2022, in Ontario, Canada’s most populous province. Data were obtained from the provincial vaccine registry and were linked to routinely used administrative databases. Six hundred family physicians whose practices had the largest number of unvaccinated rostered patients in the province were randomized 1:1 to a practice facilitation intervention or a control group. Eighteen were excluded because they were not practicing family physicians. Follow-up was completed March 31, 2022, and data were analyzed from March 2023 to May 2024. The primary analysis was by intention-to-treat; unit of analysis was the patient.

Intervention — Practice facilitators offered physicians support to identify, reach out to, and counsel their unvaccinated patients.

Main Outcomes and Measures — Any vaccine dose during a 4-month follow-up interval among rostered patients older than 12 years was used to calculate the rate of doses per 100 patients. A modified robust Poisson regression method was used to analyze intervention effects; intervention effect was estimated as relative risk (RR) using least square means differences with 95% CIs.

Results — Of 582 physicians included in the analysis (median age, 58 [IQR, 52-66] years; 426 [73.2%] male), 292 were randomized to the control arm and 290 to the intervention arm. Only 84 physicians (29.0%) in the intervention arm accepted assistance from a practice facilitator. Mean numbers of doses of COVID-19 vaccines per 100 patients were 49.8 (95% CI, 48.8-50.9) in the intervention arm and 50.2 (95% CI, 49.2-51.2) in the control arm (adjusted RR, 0.99; 95% CI, 0.96-1.02).

Conclusions and Relevance — In this study, practice facilitation to primary care clinics with high numbers of patients unvaccinated against COVID-19 was not associated with significant changes in vaccination uptake. Findings suggest the importance of ensuring that interventions target health services with high levels of both motivation and opportunity for improvement.