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Meta-Analysis
. 2005 Jul 20;2005(3):CD003941.
doi: 10.1002/14651858.CD003941.pub2.

Patient reminder and patient recall systems to improve immunization rates

Julie C Jacobson Vann  1 , Peter Szilagyi
Affiliations
Meta-Analysis

Patient reminder and patient recall systems to improve immunization rates

Julie C Jacobson Vann et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result of low immunization rates, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care and large demands on primary care physicians, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. A common theme across immunization programs in all nations involves the challenge of determining the denominator of eligible recipients (e.g. all children who should receive the measles vaccine) and identifying the best strategy to ensure high vaccination rates. Strategies have focused on patient-oriented interventions (e.g., patient reminders), provider interventions and system interventions. One intervention strategy involves patient reminder and recall systems.

Objectives: To assess the effectiveness of patient reminder and recall systems in improving immunization rates and compare the effects of various types of reminders in different settings or patient populations.

Search strategy: A systematic search was performed for the initial review using MEDLINE (1966-1998) and four other bibliographic databases: EMBASE, PsychINFO, Sociological Abstracts, and CAB Abstracts. Authors also performed a search of The Effective Practice and Organisation of Care (EPOC) register in April 2001 to update the review. Two authors reviewed the lists of titles and abstracts and used the inclusion criteria to mark potentially relevant articles for full review. The reference lists of all relevant articles and reviews were back searched for additional studies. Publications of abstracts, proceedings from scientific meetings and files of study collaborators were also searched for references. In December 2004 the EPOC register was searched to identify relevant articles to update the review.

Study design: Randomized controlled trials (RCT), controlled before and after studies (CBA) and interrupted time series (ITS) studies written in English.

Types of participants: Health care personnel who deliver immunizations and children (birth to 18 years) or adults (18 years and up) who receive immunizations in any setting.

Types of interventions: Any intervention that falls within the EPOC scope (See Group Details) and that includes patient reminder or recall systems, or both, in at least one arm of the study.

Types of outcome measures: Immunization rates or the proportion of the target population up-to-date on recommended immunizations. Outcomes were acceptable for either individual vaccinations (e.g. influenza vaccination) or standard combinations of recommended vaccinations (e.g. all recommended vaccinations by a specific date or age).

Data collection: Each study was read independently by two reviewers. Disagreements between reviewers were resolved by a formal reconciliation process to achieve consensus.

Analysis: Results are presented for individual studies as relative rates for randomized controlled trials and as absolute changes in percentage points for controlled before and after studies. Pooled results for RCTs only were presented using the random effects model.

Main results: Five new studies were added for this update. Increases in immunization rates due to reminders were in the range of 1 to 20 percentage points. Reminders were effective for childhood vaccinations (OR = 1.45, 95% CI =1.28, 1.66), childhood influenza vaccinations (OR = 2.87, 95% CI = 1.65, 4.98), adult pneumococcus, tetanus, and Hepatitis B (OR = 2.19, 95% CI = 1.21, 3.99), and adult influenza vaccinations (OR = 1.66, 95% CI = 1.31, 2.09). All types of reminders were effective (postcards, letters, telephone or autodialer calls), with telephone being the most effective but most costly.

Authors' conclusions: Patient reminder and recall systems in primary care settings are effective in improving immunization rates within developed countries.

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Conflict of interest statement

Peter Szilagyi is an author on four of the included studies.

Figures

Analysis 1.1
Analysis 1.1
Comparison 1 postcard reminder vs. control, Outcome 1 Immunized.
Analysis 2.1
Analysis 2.1
Comparison 2 letter reminders vs. control, Outcome 1 Immunized.
Analysis 3.1
Analysis 3.1
Comparison 3 phone reminders vs. control, Outcome 1 Immunized.
Analysis 4.1
Analysis 4.1
Comparison 4 autodialer vs. control, Outcome 1 Immunized.
Analysis 5.1
Analysis 5.1
Comparison 5 card & phone vs. control, Outcome 1 Immunized.
Analysis 6.1
Analysis 6.1
Comparison 6 patient & provider reminder vs. control, Outcome 1 Immunized.
Analysis 7.1
Analysis 7.1
Comparison 7 Patient Reminders (summary) vs. control, Outcome 1 Immunized.
Analysis 8.1
Analysis 8.1
Comparison 8 tracking and outreach vs. control, Outcome 1 Immunized.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

    1. Alto W, Fury D, Condo A, Doran M, Aduddell M. Improving the immunization coverage of children less than 7 years old in a family practice residency. Journal of the American Board of Family Medicine 1994;7(6):472‐477. - PubMed
    1. Baker A, McCarthy B, Gurley V, Yood M. Influenza immunization in a managed care organization. Journal of General Internal Medicine 1998;13:469‐475. - PMC - PubMed
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    1. Buchner D, Larson E, White R. Influenza vaccination in community elderly. A controlled trial of postcard reminders. Journal of the American Geriatrics Society 1987;35(8):755‐760. - PubMed

References to studies excluded from this review

    1. Abramson J, O'Shea M, Ratledge D, Lawless M, Givner L. Development of a vaccine tracking system to improve the rate of age‐appropriate primary immunization in children of lower socioeconomic status. The Journal of Pediatrics 1995;126(4):583‐586. - PubMed
    1. Alemi, Alemagno, Goldhagen, Ash, Finkelstein, Lavin, Butts, Ghadiri. Computer reminders imporve on‐time immunization rates. Medical Care 1996;34(10, Supp):OS45‐OS51. - PubMed
    1. Anderson C, Martin H. Effectiveness of patient recall system on immunization rates for influenza. The Journal of Family Practice 1979;9(4):727‐730. - PubMed
    1. Asch‐Goodkin J. Your ever‐present practice challenge: keeping the immunization level high. Contemporary Pediatrics 2006;23(8):72‐78.
    1. Barton, Schoenbaum. Improving influenza vaccination performance in an HMO setting: the use of computer‐generated reminders and peer comparison feedback.. American Journal of Public Health 1990;80(5):534‐536. - PMC - PubMed

Additional references

    1. Ad Hoc Working Group for the Development of the Standards for Pediatric Immunization Practices. Standards for pediatric immunization practices. JAMA 1993;269:1817‐1822. - PubMed
    1. Arevshatian L, Clements CJ, Misore AO, Ndumbe P, Seward JF, Taylor P. An evaluation of infant immunization in Africa: is a transformation in progress?. Bulletin of the World Health Organization 2007;85(6):449‐457. - PMC - PubMed
    1. Canadian Consensus Conference. Canadian Consensus Conference on A National Immunization Records System. http://www.hc‐sc.gc.ca/hpb/lcdc/publicat/ccdr/98vol24/dr2417ea.html. 1998. - PubMed
    1. Centers for Disease Control and Prevention. Status report on the childhood immunization initiative: national, state, and urban area vaccination coverage levels among children aged 19‐35 months‐‐ United States, 1996. MMWR. Morbidity and Mortality Weekly Report 1997;46:657‐664. - PubMed
    1. Centers for Disease Control and Prevention. Vaccination coverage by race/ethnicity and poverty level among chilren aged 19‐35 months‐‐ United States. MMWR. Morbidity and Mortality Weekly Report1997:956‐9.

References to other published versions of this review

    1. Peter G. Szilagyi, Clayton Bordley, Julie C. Vann, Ann Chelminski, Ronald M. Kraus, Peter A. Margolis, Lance E. Rodewald. Effect of Patient Reminder/Recall Interventions on Immunization Rates. JAMA 2000;284(14):1820‐1827. - PubMed
    1. Jacobson Vann JC, Szilagyi P. Patient reminder and patient recall systems for improving immunization rates. Cochrane Database of Systematic Reviews 2005, Issue 3. [DOI: 10.1002/14651858.CD003941.pub2] - DOI - PMC - PubMed