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Centralized immunization reminder/recall system more effective vs. practice-based system
A collaborative centralized immunization reminder/recall notification system was more effective and more cost effective compared with a practice-based system, according to study findings in JAMA Pediatrics.
“National 2011 data demonstrate coverage for the seven routinely recommended vaccines for children aged 19 to 35 months to be 68.5%, which is substantially lower than the national goal of 80% for children in this age group as outlined by Healthy People 2020,” study researcher Allison Kempe, MD, MPH, of Children’s Hospital Colorado, and colleagues wrote. “One method of increasing these rates … is the use of reminder/recall notification. However … use of reminder/recall notification by primary care practices nationally has been less than 20%.”
Allison Kempe
Researchers randomized seven counties in Colorado to a collaborative centralized reminder/recall approach and eight counties to a practice-based reminder/recall approach to increase immunization rates among children aged 19 to 35 months. Patients in the collaborative centralized arm were subsequently randomly assigned to an autodial/mail protocol or a mail-only protocol. Patients in the autodial/mail protocol received two autodialed calls followed by two postcards. Patients in the mail-only protocol received one letter and up to three postcards.
Practices in the practice-based arm were invited to attend webinar training that recommended sending reminder/recall notifications to preschool-aged children and follow similar methods as the collaborative centralized notification arm. Financial reimbursement was offered for mailing costs and costs for autodialed reminder/recall messages. Researchers determined which practices ran a recall report on a monthly basis. If a report was generated, researchers contacted practices to confirm if the practice sent out mailings or made telephone calls to patients.
Eighty-seven percent of eligible children in the collaborative centralized arm received at least one reminder/recall contact. Only two practices in the practice-based arm conducted reminder/recall notifications and thus, 0.8% of children in this arm received notifications.
Approximately 25% of children in the collaborative centralized arm received a new vaccine compared with 21.7% of children in the practice-based arm.
Up-to-date immunization status was achieved in 11% of children in the collaborative centralized arm vs. 8.5% of children in the practice-based arm.
The cost per child receiving any vaccine was more than six times higher in the practice-based arm vs. the collaborative centralized arm. Further, the cost per child achieving up-to-date vaccination status was five times higher in the practice-based arm vs. the collaborative centralized arm.
“This study demonstrated greater effectiveness and cost-effectiveness of a [collaborative centralized immunization information system]-based reminder/recall approach compared with a [practice-based] reminder/recall approach for increasing rates of immunization among populations of preschool-aged children,” Kempe and colleagues wrote.
According to Alexander G. Fiks, MD, MSCE, of The Children’s Hospital of Philadelphia, the concept that traditional implementation methods of recall/reminder notification systems may not succeed in every practice is noteworthy.
“The study by Kempe et al recognizes that, for many practices, the benefits of implementing reminder/recall systems fail to outweigh the perceived burden,” Fiks wrote in an accompanying editorial. “Practices in counties randomized to reminder/recall notification were offered financial reimbursement yet still declined to participate, suggesting that barriers to the reminder/recall intervention were more than financial.”
Overall, the study findings suggest that collaboration is key to implementing successful, effective immunization reminder/recall notification systems, Fiks said.
The study illustrates, “in certain settings, especially one where the interests of the practice and public health care systems coincide, collaboration with outside groups may prove most effective,” Fiks wrote. “Even so, the results of this study remind us that as these collaborations develop, they benefit from building on existing relationships between families and clinicians.”
Disclosure: Fiks reports financial ties with Pfizer. The other researchers report no relevant financial disclosures.
