Notice to Readers
Recommendations of the Advisory Committee on Immunization Practices,
the American Academy of Pediatrics, and the American Academy of
Family Physicians: Use of Reminder and Recall by Vaccination Provide
This statement by the Advisory Committee on Immunization
Practices
(ACIP), the American Academy of Pediatrics (AAP), and the American
Academy
of Family Physicians (AAFP) presents and recommends a programmatic
strategy -- the use of a reminder and/or recall (R/R) system by
vaccination
providers -- to increase vaccination rates. In 1992, a national
survey
indicated that 8% of pediatricians and 5% of family physicians had
implemented a manual vaccination R/R system and 6% and 5%,
respectively,
used a computer-based system for vaccination R/R messages (1). In
1993, the
National Vaccine Advisory Committee issued the "Standards for
Pediatric
Immunization Practices," which recommend that all public and
private
health-care providers use a vaccination R/R system (2). These
standards
were endorsed by ACIP, AAP, and AAFP. By 1995 a survey indicated
that R/R
systems were used by 35% of pediatricians and 23% of family
physicians (R.
Zimmerman, University of Pittsburgh School of Medicine, personal
communication, 1995).
The reminder component consists of mail and/or telephone
messages to
remind parents or guardians of vaccination due dates for their
children.
Reminder messages can improve parents' awareness that vaccinations
are due
and the importance of keeping appointments, therefore increasing
the
up-to-date vaccination status of children. The recall component
consists of
mail and/or telephone messages to parents or guardians of children
who are
past due for one or more vaccinations. Recall messages can decrease
vaccination drop-out rates and reduce the time children remain at
risk for
vaccine-preventable diseases. R/R systems can be operated manually
(e.g.,
by monthly tickler file) or can be automated (e.g., by
computer-generated
mailings or telephone calls). Messages from automated systems can
be
modified to address special needs (e.g., language).
The implementation of vaccination R/R systems has potential
benefits
beyond improved vaccination coverage rates. Patients of all ages
who are
due or overdue for recommended vaccinations also may have fallen
behind in
health supervision visits and may experience barriers to health
care in
general. Vaccination R/R systems may help identify patients who are
at risk
for not receiving comprehensive primary care. R/R systems also can
be
established independently for improving attendance for child health
supervision visits and other recommended preventive health service
visits,
including adult vaccination (3), cervical cancer screening (4), and
lead
screening. The cost-effectiveness of R/R systems for a provider can
be
dependent on the number of patients, the documented level of
vaccination
coverage, the provider's level of computerization, and the
intensity with
which the provider uses the R/R system (5,6).
Properly implemented, the R/R strategy contributes to high,
sustainable vaccination coverage levels. Studies of the
effectiveness of
mail or telephone reminder messages generally have demonstrated
improvements in patient compliance for a variety of scheduled
health-care
visits, including vaccinations (7-9). Among patients scheduled for
a
vaccination visit who received a single autodialer-based reminder
call the
night before a scheduled visit, attendance was 57% compared with
20% in the
control group who received no reminder (6); 41% of patients who
received a
vaccination R/R message visited the provider within 30 days
compared with
28% of those who did not receive a reminder (10).
The ACIP, AAFP, and AAP recommend the regular use of R/R
systems by
public and private health-care providers in settings that have not
achieved
high documented levels of age-appropriate vaccinations. For
reminder
systems, messages should be delivered close to the due date for
vaccinations. In recall systems, messages should be delivered
promptly if
the scheduled visit is missed. Implementation of these
recommendations can
contribute substantially to improving vaccination coverage at the
provider
level.
Reported by: Advisory Committee on Immunization Practices, Atlanta,
Georgia. American Academy of Family Physicians, Kansas City,
Missouri.
American Academy of Pediatrics, Elk Grove Village, Illinois.
Immunization
Svcs Div, National Immunization Program, CDC.
References
Szilagyi PG, Rodewald LE, Humiston SG, et al. Immunization
practices of
pediatricians and family physicians in the United States.
Pediatrics
1994;94:517-23.
Ad Hoc Working Group for the Development of Standards for
Pediatric
Immunization Practices. Standards for pediatric immunization
practices.
JAMA 1993;269:1817-22.
Barton MB, Schoenbaum SC. Improving influenza vaccination
performance
in an HMO setting: the use of computer-generated reminders and
peer
comparison feedback. Am J Public Health 1990;80:534-6.
Austin SM, Balas EA, Mitchell JA, Ewigman BG. Effect of
physician
reminders on preventive care: meta-analysis of randomized
clinical
trials. Proc 18th Annu Symp Comput Appl Med Care 1994:121-4.
Lieu TA, Black SB, Ray P, et al. Computer-generated recall
letters for
underimmunized children: how cost-effective? Pediatr Infect Dis
J 1997;
16:28-33.
Dini EF, Linkins RW, Chaney M. Effectiveness of
computer-generated
telephone messages in increasing clinic visits. Arch Pediatr
Adolesc
Med 1995;149:902-5.
Campbell JR, Szilagyi PG, Rodewald LE, Doane C, Roghmann KJ.
Patient-specific reminder letters and pediatric well-child-care
show
rates. Clinical Pediatrics 1994;33:268-72.
Nazarian LF, Mechaber J, Charney E, Coulter MP. Effect of a
mailed
appointment reminder on appointment keeping. Pediatrics
1974;53:349-52.
Linkins RW, Dini EF, Watson G, Patriarca PA. A randomized trial
of the
effectiveness of computer-generated telephone messages in
increasing
immunization visits among preschool children. Arch Pediatr
Adolesc Med
1994;148:908-14.
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