# Practice Facilitation to Support Primary Care Physicians With COVID-19 Vaccine Uptake: A Randomized Clinical Trial

## TL;DR

A study in Ontario found that practice facilitation did not significantly increase COVID-19 vaccination rates among primary care physicians with many unvaccinated patients.

## Contribution

This is the first randomized clinical trial to assess the effectiveness of practice facilitation in improving vaccine uptake in primary care settings.

## Key findings

- Practice facilitation had no significant impact on vaccination rates compared to the control group.
- Only 29% of physicians in the intervention group accepted facilitation assistance.
- The study suggests interventions should target clinics with both high motivation and opportunity for improvement.

## Abstract

Does a multicomponent practice facilitation intervention increase COVID-19 vaccination rates among practices of family physicians with the largest number of unvaccinated patients?

In this randomized clinical trial of 582 physicians, the intervention had no significant impact on vaccination uptake. The adjusted relative risk for vaccine doses per 100 patients was 0.99, indicating no difference in vaccination rates between the intervention and control groups.

These findings suggest that future interventions should target health services with both high motivation and opportunity for improvement to be more effective.

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.

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.

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.

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

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.

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).

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.

ClinicalTrials.gov Identifier: NCT05099497

This cluster-randomized clinical trial assesses whether availability of a multicomponent practice facilitation intervention for family physicians with large numbers of unvaccinated patients would increase COVID-19 vaccine uptake in Ontario, Canada.