Effect of patient reminder/recall interventions on immunization rates - A review

Context Immunization rates for children and adults remain below national go als. While experts recommend that health care professionals remind patients of needed immunizations, few practitioners actually use reminders. Little is known about the effectiveness of reminders in different settings or pati ent populations. Objectives To assess the effectiveness of patient reminder systems in impro ving immunization rates, and to compare the effectiveness of different type s of reminders for a variety of patient populations. Data Sources A search was performed using MEDLINE, EMBASE, PsychINFO, Socio logical Abstracts, and CAB Health Abstracts. Relevant articles, as well as published abstracts, conference proceedings, and tiles of study collaborato rs, were searched for relevant references. Study Selection and Data Extraction English-language studies involving pati ent reminder/recall interventions (using criteria established by the Cochra ne Collaboration) were eligible for review if they involved randomized cont rolled trials, controlled before-after studies, or interrupted time series, and measured immunization rates. Of 109 studies identified, 41 met eligibi lity criteria. Studies were reviewed independently by 2 reviewers using a s tandardized checklist. Results of studies are expressed as absolute percent age-point changes in immunization rates and as odds ratios (ORs). Studies w ith similar characteristics of patients or interventions were pooled (rando m effects model). Data Synthesis Patient reminder systems were effective in improving immuniz ation rates in 33 (80%) of the 41 studies, irrespective of baseline immuniz ation rates, patient age, setting, or vaccination type. Increases in immuni zation rates due to reminders ranged from 5 to 20 percentage points. Remind ers were effective for childhood Vaccinations (OR, 2.02; 95% confidence int erval [CI], 1.49-2.72), childhood influenza vaccinations (OR, 4.25; 95% CI, 2.10-8.60), adult pneumococcus or tetanus vaccinations (OR, 5.14; 95% CI, 1.21-21.78), and adult influenza vaccinations (OR, 2.29; 95% CI, 1.69-3.10) ? While reminders were most effective in academic settings (OR, 3.33; 95% C I, 1.98-5.58), they were also highly effective in private practice set ting s (OR, 1.79; 95% CI, 1.45-2.22) and public health clinics (OR, 2.09; 95% CI , 1.42-3.07). All types of reminders were effective (postcards, letters, an d telephone or autodialer calls), with telephone reminders being most effec tive but costliest. Conclusions Patient reminder systems in primary care settings are effective in improving immunization rates. Primary care physicians should use patien t reminders to improve immunization delivery.