Effectiveness and Net Cost of Reminder/Recall for Adolescent Immunizations

Suh, Christina; Saville, Alison W.; Daley, Matthew F.; Glazner, Judith E.; Barrow, Jennifer; Stokley, Shannon; Dong, Fran; Beaty, Brenda; Dickinson, L. Miriam; Kempe, Allison

doi:10.1542/peds.2011-1714

Cited by 97 publications

(97 citation statements)

References 23 publications

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“…Importantly, the cost per additional adolescent vaccinated was higher than the cost per additional individual vaccinated reported in some studies [50][51][52] but in the range of other studies 17,53 and less than the costs for stepped reminder/outreach interventions 27,28 ; also the benefits involved both improved immunizations and greater preventive care visits.…”

Section: Discussionmentioning

confidence: 73%

“…13,14 Nevertheless, little evidence exists for the effectiveness of practice-based reminder/recall for adolescent immunizations, 15,16 although in one recent study in 4 practices researchers demonstrated increased immunization rates. 17 Moreover, few practices actually use reminder/recall for patients of any age [18][19][20] ; barriers include the added workload, costs, and complexities of conducting such a program. 21,22 Furthermore, some recent studies targeting low-income populations found little or no benefit to practice-based reminder/recall for young children because of difficulties in reaching families that often change addresses or telephone numbers.…”

Section: Introductionmentioning

confidence: 99%

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

Szilâgyi

Albertin

Humiston

et al. 2013

Academic Pediatrics

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107

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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.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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

Szilâgyi

Albertin

Humiston

et al. 2013

Academic Pediatrics

Self Cite

107

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“…55,56 The positive effect of our dose 2 and 3 telephone recalls on improving completion corresponds with other studies of urban, underserved adolescent populations. 21,23,57,58 Only 5% to 25% of US pediatric practices use reminder/recall interventions. 59,60 Key implementation barriers include lack of human and financial resources, low confidence that immunization histories are up-to-date, and need for accurate contact information.…”

Section: Discussionmentioning

confidence: 99%

Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial

et al. 2015

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OBJECTIVES: Evaluate effects of a multicomponent intervention (human papillomavirus [HPV] vaccine-specific brochure and recalls) on HPV vaccination and secondarily examine if race/ethnicity moderates effects.METHODS: Unvaccinated girls aged 11 to 18 years attending 4 safety-net pediatric clinics and their parent/guardian (n = 814 dyads) were randomized to (1) active comparison (general adolescent vaccine brochure), or (2) intervention consisting of a HPV vaccine-specific brochure, telephone recalls to parents who declined, and recalls to patients overdue for doses 2 and 3. HPV 1-dose and 3-dose coverages were assessed via electronic health records 12 months after randomization. Multivariate logistic regressions estimated adjusted odds and marginal predicted vaccine coverage by study arm and race/ethnicity.RESULTS: Intent-to-treat analyses found no main effect of the HPV vaccine-specific brochure on 1-dose coverage (42.0% vs 40.6%); however, secondary analyses found race/ethnicity was a significant moderator such that the intervention was effective only for Hispanic individuals (adjusted odds ratio [AOR] 1.43; 95% confidence interval [CI] 1.02-2.02), and not effective for black individuals (AOR 0.64; 95% CI 0.41-1.13). Recalls to parents who declined the vaccine during the index visit were not effective, but recalls to patients overdue for doses 2 and 3 were effective at increasing 3-dose coverage regardless of race/ethnicity (AOR 1.99; 95% CI 1.16-3.45).CONCLUSIONS: Educational materials describing only the HPV vaccine were effective for Hispanic but not black individuals. Future research should test mechanisms that may mediate intervention effects for different racial/ethnic groups, such as different informational needs or vaccine schemas (experiences, beliefs, norms). WHAT'S KNOWN ON THIS SUBJECT:Previous studies have evaluated separately the effects of brief education and reminder/recall intervention strategies to increase human papillomavirus vaccine coverage. None have examined if intervention effects varied by race/ethnicity. WHAT THIS STUDY ADDS:When compared with a general adolescent vaccine brochure, human papillomavirus vaccine-specific educational materials increased 1-dose coverage among Hispanic but not black individuals. Recalls for doses 2 and 3 were effective in increasing 3-dose coverage for both racial/ethnic groups.

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“…28 The results of these studies underscore the importance of reliable contact information as a prerequisite for effective family-focused intervention.…”

Section: Articlementioning

confidence: 93%

“…In addition, although basic reminder calls to families have proven effective in fostering vaccination, 26 only 2 studies of reminder calls for adolescent vaccination have been published, revealing mixed results. 27,28 Although CDS has been defined as including alerts to clinicians or families, 29 researchers have not conducted large-scale trials of automated, EHR-based decision support directed at both clinicians and families in any context. Given multiple family and clinician barriers to HPV vaccination, this strategy may better address obstacles to vaccine receipt than either family-focused or CDS alone.…”

mentioning

confidence: 99%

Effectiveness of Decision Support for Families, Clinicians, or Both on HPV Vaccine Receipt

Fiks

Grundmeier

Mayne³

et al. 2013

Pediatrics

190

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WHAT'S KNOWN ON THIS SUBJECT: Despite proven health benefits, human papillomavirus (HPV) vaccination rates are among the lowest of all routine immunizations. No previous largescale trial has compared the benefit of automated decision support directed at clinicians, families, or both in any context. WHAT THIS STUDY ADDS:We found that a clinician-focused intervention was most effective for initiating the HPV vaccine series, whereas a family-focused intervention supported completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt. abstract OBJECTIVE: To improve human papillomavirus (HPV) vaccination rates, we studied the effectiveness of targeting automated decision support to families, clinicians, or both.METHODS: Twenty-two primary care practices were cluster-randomized to receive a 3-part clinician-focused intervention (education, electronic health record-based alerts, and audit and feedback) or none. Overall, 22 486 girls aged 11 to 17 years due for HPV vaccine dose 1, 2, or 3 were randomly assigned within each practice to receive family-focused decision support with educational telephone calls. Randomization established 4 groups: family-focused, clinician-focused, combined, and no intervention. We measured decision support effectiveness by final vaccination rates and time to vaccine receipt, standardized for covariates and limited to those having received the previous dose for HPV #2 and 3. The 1-year study began in May 2010. RESULTS:Final vaccination rates for HPV #1, 2, and 3 were 16%, 65%, and 63% among controls. The combined intervention increased vaccination rates by 9, 8, and 13 percentage points, respectively. The control group achieved 15% vaccination for HPV #1 and 50% vaccination for HPV #2 and 3 after 318, 178, and 215 days. The combined intervention significantly accelerated vaccination by 151, 68, and 93 days. The clinician-focused intervention was more effective than the familyfocused intervention for HPV #1, but less effective for HPV #2 and 3.CONCLUSIONS: A clinician-focused intervention was most effective for initiating the HPV vaccination series, whereas a family-focused intervention promoted completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt.

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Effectiveness and Net Cost of Reminder/Recall for Adolescent Immunizations

Abstract: R/R was successful at increasing immunization rates in adolescents and effect sizes were comparable to those in younger children. Practices conducting R/R may benefit financially if they can generate additional well-child care visits and keep supply costs low.

Cited by 97 publications

References 23 publications

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

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

Promoting HPV Vaccination in Safety-Net Clinics: A Randomized Trial

Effectiveness of Decision Support for Families, Clinicians, or Both on HPV Vaccine Receipt

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