Provider Attitudes Toward Public-Private Collaboration to Improve Immunization Reminder/Recall: A Mixed-Methods Study

Abstract

Objective To assess primary care providers’ current reminder/recall practices, preferences for collaboration with health departments in reminder/recall efforts, attitudes toward practice-based and population-based reminder/recall, and experiences with a population-based reminder/recall intervention. Methods Providers responsible for making decisions about immunization delivery at all primary care practices that participate in the Colorado Immunization Information System were surveyed. Data collection was preceded by an intervention in which half of 14 counties received a population-based reminder/recall intervention conducted by the health department. Practice staff involved in immunization activities were then selected for semi-structured telephone interviews based on the location of their practice within specified strata, including whether they were in the intervention counties, urban/rural location, and practice type. Results 282/383 (73.6%) of providers responded to the survey and 253 who administered vaccines to children 19-35 months were retained; 82 staff members at 36 practices were interviewed. Providers’ preferences for who should conduct reminder/recall were almost evenly split, with slightly more indicating that it should be conducted by the health department. Cost and feasibility issues were perceived barriers to conducting practice-based recall, particularly among urban practices. Support for population-based reminder/recall was highest among rural practices. Concern about perceived inaccuracies in immunization registry data was the major barrier to conducting population-based reminder/recall. The population-based intervention did not create an undue burden on practices. Conclusions A collaborative approach to reminder/recall involving both providers and health departments is preferable for many providers and may be a viable solution to the barriers of practice-based reminder/recall.

Organizational factors influencing successful primary care and public health collaboration

“…Other research published since the scoping literature review validates and expands on our findings. Organizational influences on collaboration identified in our research and supported by the work of others include: the importance of sharing of health data and compatible information systems [ 25 – 28 ], and developing mechanisms and structures for coordination and inter-organizational communication [ 29 , 30 ]. Data sharing along with effective communication and coordination structures (influencing factor 2) enabled opportunities for leveraging the distinct strengths of each sector.…”

“…Data sharing along with effective communication and coordination structures (influencing factor 2) enabled opportunities for leveraging the distinct strengths of each sector. For example, in an immunization campaign carried out in Colorado [ 29 ], PH took responsibility for a patient recall/notification program, a population health measure, while PC received patients for administering vaccines, offering individual health care. Despite positive reports in our study as well as other research related to successful exchange of client information, much more work is needed to close the data sharing loop.…”

“…Sharing of resources to deliver programs (influencing factor 7) may be an incentive for collaboration [ 29 , 31 ] although designated or realignment of resources (i.e., funding) for collaboration (influencing factor 5) are also needed [ 12 , 15 , 27 – 29 ], as well as human resources to support collaborations (influencing factor 6) [ 5 ]. With respect to optimal use of resources (influencing factor 5), geographic proximity or use of shared space was often highlighted in the literature as important resulting in synergies for achieving both PC and PH service objectives [ 11 , 12 , 15 ].…”

“…In the cases presented in the literature, PC and PH roles are articulated and their specific skill sets and resources utilized toward a common objective. Examples include: immunization [ 29 , 31 ], obesity campaigns [ 8 ], infectious disease and syndromic surveillance [ 25 , 27 ], sexually transmitted infection management [ 10 , 35 ] and diabetes prevention [ 36 ]. In these examples, a culture of collaboration (influencing factor 4) is encouraged through an awareness of each other and what each can offer [ 5 , 12 , 35 ].…”

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

“…Most health providers and parents are in favor of C-R/R. 18,22,23 Previous trials revealed that C-R/R by using IISs for routine childhood vaccines (ie, not adolescent vaccines) was more effective and cost-effective than practice-based R/R. [24][25][26][27] HPV vaccination is more challenging than other adolescent vaccines 8 because of the need for multiple doses 28 and frequent parent questions 29 or vaccine hesitancy.…”