A Randomized Trial of the Effect of Centralized Reminder/Recall on Immunizations and Preventive Care Visits for Adolescents

Abstract

Objective-To assess the impact of a managed care-based patient reminder/recall system on immunization rates and preventive care visits among low-income adolescents.Methods-We conducted a randomized controlled trial between December 2009 and December 2010 that assigned adolescents aged 11-17 years to one of three groups: mailed letter, telephone reminders, or control. Publicly insured youths (n = 4, 115) were identified in 37 participating primary care practices. The main outcome measures were immunization rates for routine vaccines (meningococcus, pertussis, HPV) and preventive visit rates at study end.Results-Intervention and control groups were similar at baseline for demographics, immunization rates, and preventive visits. Among adolescents who were behind at the start, immunization rates at study end increased by 21% for mailed (P < .01 vs control), 17% for telephone (P < .05), and 13% for control groups. The proportion of adolescents with a preventive visit (within 12 months) was: mailed (65%; P <.01), telephone (63%; P <.05), and controls (59%). The number needed to treat for an additional fully vaccinated adolescent was 14 for mailed and 25 for telephone reminders; for an additional preventive visit, it was 17 and 29. The intervention cost $18.78 (mailed) or $16.68 (phone) per adolescent per year to deliver. The cost per additional adolescent fully vaccinated was $463.99 for mailed and $714.98 for telephone; the cost per additional adolescent receiving a preventive visit was $324.75 and $487.03.Conclusions-Managed care-based mail or telephone reminder/recall improved adolescent immunizations and preventive visits, with modest costs and modest impact.

Interventions to Improve HPV Vaccine Uptake: A Systematic Review

“…They found improved vaccination rates among those who received reminders but no significant difference based on modality. 74 Chao et al demonstrated increased HPVV completion rates among participants randomized to receive reminder letters versus standard of care (56.4% vs 46.6%). 62 Both investigators identified a lack of reliable contact information as a barrier to implementation.…”

“…62 Both investigators identified a lack of reliable contact information as a barrier to implementation. 62,74 Another trial randomized patients to receive telephone and mail reminders versus standard of care and showed significantly higher initiation (26.5% vs 15.3%) and completion rates (11.4% vs 4.4%) among the intervention group. 35 Two interventions used text message reminders; both showed significantly higher rates in the intervention group (51.6% vs 35%) 67 and (16% vs 5%).…”

“…69 Another text message reminder intervention failed to demonstrate a difference between intervention and control groups, which authors postulated was potentially due to inadequate follow-up time. 36 Several articles commented on the financial feasibility 34,35,62,69,74 and acceptability by parents 69 of reminder interventions.…”

Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial

“…To capitalize on this opportunity, future studies should seek to better understand which of the AFIX quality improvement strategies are most effective for increasing adolescent vaccine coverage, while continuing to explore approaches, such as webinar delivery, for maximizing program efficiency. In the long term, understanding how AFIX compares with other evidence-based strategies, such as centralized reminder/recall, [14][15][16] will also be important for helping state health departments allocate limited funds for immunization quality improvement.…”

Practical Approaches to Optimize Adolescent Immunization

“…For adolescents who were not caught up with vaccinations at the start of the study, uptake significantly increased by 21% for mail-reminder groups and by 17% for telephone-reminder groups versus only 13% for control groups. 48 A study on HPV vaccination rates, conducted in managed care organizations, found that text message reminders had a modest effect on HPV dose 1 rates for those who were able to receive the text message with valid phone numbers in the database. 49 In another study, postal mail, e-mail, or text reminders were used to improve adolescent vaccination rates.…”