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Reuters Health Information: Patient reminders, recall interventions improve immunization rates

Patient reminders, recall interventions improve immunization rates

Last Updated: 2018-01-23

By Will Boggs MD

NEW YORK (Reuters Health) - Patient-oriented interventions, including patient reminder and recall, can significantly increase immunization rates, according to a systematic review.

"The patient reminder and recall methods work, regardless of whether the studies involved the use of telephone, postcard, letter, autodialer message, or text message, regardless of the age of patients and for all types of vaccines," Dr. Julie C. Jacobson Vann from the University of North Carolina at Chapel Hill and Dr. Robert M. Jacobson from Mayo Clinic, Rochester, Minnesota, told Reuters Health by email. "We find it interesting that nearly all included studies demonstrated positive results, even those that involved patients who had not received vaccinations in prior years."

Patient reminders notify populations, individuals, or their parents or legal guardians of vaccines that come due because of age or other risk factors, and patient recalls include notifications of vaccines that are past due. Both have been shown to improve immunization rates.

Dr. Jacobson Vann, Dr. Jacobson, and colleagues evaluated and compared the effectiveness of various types of reminder and recall interventions to improve receipt of immunizations in their updated review of literature and trial registers to January 2017.

The 75 studies addressed in their Cochrane Database of Systematic Reviews online report, January 18, involved child, adolescent and adult participants in outpatient, community-based, primary care, and other settings in 10 countries.

Moderate-certainty evidence from 55 studies with 138,625 participants showed that either intervention, or combinations thereof, improved the proportion of participants who received immunizations by a relative 28%, with absolute improvements of 8 percentage points.

High-certainty evidence indicated significant immunization-rate improvements with the use of postcards (18% relative improvement), text messages (29%), and autodialer message (17%), while moderate-certainty evidence supported the use of telephone calls (75% relative improvement) and letters to patients (29%).

Reminders improved immunization rates by 22% in childhood and by 29% in adolescence, and moderate-certainty evidence suggested that reminders improved receipt of vaccinations for childhood influenza (51% relative improvement) and adult influenza (29%).

Low-certainty evidence suggested that these interventions might also improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non-influenza vaccinations.

"Given our findings that all of the methods were effective, physicians, other clinicians, and health systems should choose among the options the one that makes the most sense for their situation," Dr. Jacobson Vann and Dr. Jacobson said. "Factors such as human and other resources, system capability, and completeness and accuracy of patient and family contact information are important to making decisions about (which) patient reminder and recall method to use."

"Health insurers, public health authorities, and governmental agencies committed to improving the health of their populations should support reminder and recall systems," they conclude.


Cochrane Database Syst Rev 2018.

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