Reminder Cards and Immunization Rates Among Latinos and the Rural Poor in Northeast Colorado

Abstract

Objective: Immunization rates are static in the United States. Risk factors for not being up to date (UTD) include ethnicity and lower socioeconomic status. Reminder cards increase immunization rates in urban settings. Their effect in poor, Latino, and rural children is unknown.Background: Language-appropriate reminder cards were sent to active patients not UTD listing the vaccines missing; the card served as the physician order for the vaccine. Missed opportunities were addressed through discussion with staff and posters in patient care rooms. UTD rates before and after intervention were measured.Results: Dual-purpose reminder/order cards increased the rate of UTD from 61.3% to 73.4%; children living near the clinic, patients who speak only Spanish, and Latinos overall showed preferential effectiveness. Children eligible to participate in the Vaccines for Children program had similar increases in UTD rates but had lower baseline and final UTD rates than did children not eligible for the Vaccines for Children program. The rate of missed opportunities did not change. The number of children to whom reminder cards needed to be sent for them to become fully immunized is 8 (number needed to treat).Conclusions Immunization rates in the United States have reached a plateau in the last several years; several states, including Colorado, show rates far below national averages.1,2 After steadily rising through the 1980s, minimal improvement was seen in the 1990s. There are many theories as to why this glass ceiling exists. Among them are parental concerns about vaccine side effects and safety, the increasing complexity of the recommended immunization schedule, and competing demands in a busy office setting. Missed opportunities represent a special concern because they occur with high frequency and account for much of the immunization delay seen in practice, specifically for at-risk children. 3,4 It is clear, however, that for some populations, the ceiling is lower than for others. Minorities and the poor have higher rates of not being up to date than do wealthier or white children.5-11 The consequence of incomplete immunization is the persistent occurrence of vaccine-preventable diseases. Many strategies have been recommended to improve immunization rates. [12][13][14][15][16][17][18][19] The Vaccine for Children (VFC) program was developed to help ameliorate the inequities in vaccinations inherent in people living in poverty and to increase minorities' access to free vaccines. 20,21 The use of computer-based vaccine registries is increasing in the United States, with over half of all children younger than 6 years of age enrolled in 2005. 22These registries provide the benefits of accessibility in many patient care settings, thereby decreasing chances that one site will inappropriately vaccinate a child. These and other arguments in their favor have been extensively published. 12,[23][24][25][26] Arguments against these registries include the large labor costs of data entry and inconsistent or incomplete data entry leading...

Primary care strategies to improve childhood immunisation uptake in developed countries: systematic review

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The effect of social determinants on immunization programs

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Health Care Quality-Improvement Approaches to Reducing Child Health Disparities

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