KEYWORDS:
Immunization, Barriers, Incentives, Reminder and Recall, Evaluation

BACKGROUND:
Following the measles outbreak in 1990 - 1991, public health clinic staff began looking at ways to reduce barriers and improve the very low immunization rates found in our rural public health department clinic. According to the California Department of Health Services, immunization record assessments performed in 1993, only 28% of children 24 months of age recieving immunizations through this public health department immunization clinic were found to have all age appropriate immunizations. Three simple cost effective strategies were implemented over a one year period and were studied retrospectively to determine effectiveness in reducing barriers and improving immunization rates. The strategies included the use of incentives, such as a baby photo book, the establishment of routine evening clinic hours and an intensive reminder and recall program that involved, postcards and personal phone calls. Immunization and clinic records were retrospectively reviewed to obtain documentation of clinic attendance and immunization rate improvement.

OBJECTIVE(S):
To evaluate the effectiveness of three different strategies which were utilized to decrease barriers to immunization and increase immunization rates in a rural public health clinic setting.

METHOD(S):
Each strategy was observed for it's effectiveness, and a comparative analysis for immunization rate improvement was performed, utilizing Centers for Disease Control and Prevention provided software and manual immunization record retrieval and review.

RESULT(S):
During the five year study period, immunization rates of children 24 months of age rose from 28% in 1993 to over 88% in 1999.

CONCLUSIONS(S):
Barriers to timely and age appropriate immunization may be decreased through the use of cost effective strategies such as incentives, increased immunization clinic hours and reminder and recall programs.

LEARNING OBJECTIVES:
Describe cost effective strategies that may be easily replicated which may decrease barriers to immunization and improve overall immunization rates.