Immunization recall: Effectiveness and barriers to success in an urban teaching clinic

Objective: To examine effectiveness of immunization recall in an urban pedi atric teaching clinic and to identify barriers to recall effectiveness. Design: Randomized, controlled trial. Children aged 5 to 17 months who were not up to date (UTD) with recommended immunizations were identified and as signed to intervention (n = 294) or control groups (n = 309). The intervent ion consisted of a mailed postcard and up to 4 telephone calls. Two months after intervention, UTD status, visit, and probable missed opportunity rate s were assessed. Results: Of the intervention group, 30% could not be reached. In 12-month-o ld children in the intervention group compared with those in the control gr oup, there was a trend toward higher UTD rates (51% vs 39%, P = .07) and a higher proportion of UTD children receiving immunizations as opposed to get ting more complete documentation (25% vs 10%, P = .005). Similar difference s between intervention and control children were not seen in the 7-month an d 19-month age categories. More children in the intervention group had a he alth maintenance visit (17% vs 11%, P = .03). Of children in the interventi on group who were seen when not UTD, 17 of 24 (71%) of those seen for an il lness visit and 5 of 24 (21%) of those seen for health maintenance probably had missed opportunities to be immunized. Conclusions: Recall efforts were partially successful but were undermined b y inability to reach the clinic population, poor documentation of immunizat ions, and missed opportunities.