Effect of State Immunization Information System Centralized Reminder and Recall on HPV Vaccination Rates

Abstract

BACKGROUND: Although autodialer centralized reminder and recall (C-R/R) from state immunization information systems (IISs) has been shown to raise childhood vaccination rates, its impact on human papillomavirus (HPV) vaccination rates is unclear. METHODS: In a 4-arm pragmatic randomized controlled trial across 2 states, we randomly selected practices representative of the specialty (pediatrics, family medicine, and health center) where children received care. Within each practice, patients 11 to 17.9 years old who had not completed their HPV vaccine series (NY: N = 30 616 in 123 practices; CO: N = 31 502 in 80 practices) were randomly assigned to receive 0, 1, 2, or 3 IIS C-R/R autodialer messages per vaccine dose. We assessed HPV vaccine receipt via the IIS, calculated intervention costs, and compared HPV vaccine series initiation and completion rates across study arms. RESULTS: In New York, HPV vaccine initiation rates ranged from 37.0% to 37.4%, and completion rates were between 29.1% and 30.1%, with no significant differences across study arms. In Colorado, HPV vaccine initiation rates ranged from 31.2% to 33.5% and were slightly higher for 1 reminder compared with none, but vaccine completion rates, ranging from 27.0% to 27.8%, were similar. On adjusted analyses in Colorado, vaccine initiation rates were slightly higher for 1 and 3 C-R/R messages (adjusted risk ratios 1.07 and 1.04, respectively); completion rates were slightly higher for 1 and 3 C-R/R messages (adjusted risk ratios 1.02 and 1.03, respectively). CONCLUSIONS: IIS-based C-R/R for HPV vaccination did not improve HPV vaccination rates in New York and increased vaccination rates slightly in Colorado. WHAT'S KNOWN ON THIS SUBJECT: Although centralized reminder and recall by phone (autodialer) has been shown to improve childhood vaccination rates, little is known about its impact on human papillomavirus (HPV) vaccination rates, particularly when coming from state immunization information systems. WHAT THIS STUDY ADDS: In a pragmatic randomized clinical trial, immunization information systems-based centralized reminder and recall for the HPV vaccine did not raise HPV vaccination rates in New York and raised rates minimally in Colorado. More intensive but perhaps less scalable interventions are warranted.

Strategies to improve human papillomavirus vaccination rates among adolescents in family practice settings in the United States: A systematic review

“…Generally, series completion rates improved in the intervention group compared with the control group (Cates et al, 2018; Henrikson et al, 2018; McGaffey et al; Perkins et al, 2020; Zimmerman et al, 2017). Studies by McClean et al (2017) and Szilagyi et al (2015, 2020) did not demonstrate any improvement with the interventions implemented.…”

“…Overall, vaccine series initiation rates improved in the intervention group compared with the control group (Bar‐Shain et al, 2015; Henrikson et al, 2018; McGaffey et al, 2018; Perkins et al, 2020; Rand et al, 2017; Zimmerman et al, 2017) ; however, McClean et al (2017) noted that children in the age group of 13–17 years were not significantly influenced by the intervention, while children in the age group of 11–12 years were significantly influenced. Szilagyi et al (2020) only reported improvement in initiation rates following a single phone call in Colorado practices, but otherwise did not report any improvements following intervention. Szilagyi et al (2015) was the only study that did not see any improvement with the interventions implemented.…”

“…Pooled analysis of five randomised controlled trials (Figure 4) demonstrated a significant increase in the primary outcome of interest, increased vaccination rates, in favour of reminders to promote vaccinations (Dose 1 RR 1.03, 95% CI 1.00, 1.06; Dose 3 RR 1.05, 95% CI 1.01, 1.08; overall RR 1.04, 95% CI 1.02, 1.06). Rand et al (2016) and Szilagyi et al (2020) used phone calls; Henrikson et al (2018) used phone call and mail; Rand et al (2016) used text messages; Szilagyi et al (2015) used provider reminder; and Dempsey et al (2019) used tailored messages using iPads in office waiting rooms. Given that Rand et al (2016) tested two interventions, we analysed both groups separately.…”

“…Limitations, however, were also identified within the included study designs. First, three studies used data from immunisation registries that contained incomplete or inaccurate information placing them at a risk for bias due to missing data (Cates et al, 2018; Dempsey et al, 2019; Szilagyi et al, 2020). Second, McGaffey et al (2019) and Rand et al (2017) implemented intervention strategies that required resource‐intense support from practices, which may affect the strategies’ sustainability.…”

“…Additionally, differences in sample sizes, practice characteristics and/or baseline HPV vaccination rates (Szilagyi et al, 2015; Zimmerman et al, 2017) still existed between intervention and control groups, despite randomisation implying potential selection bias. Finally, Cates et al (2018), McClean et al (2017), and Szilagyi et al (2020) implemented interventions during or around the time of other HPV vaccine initiatives, which may have resulted in confounding effects.…”