BACKGROUND:
Since July 2001, LACIP staff trained providers in over 280 private and public clinics on the use of R&R. During the initial field visit, LACIP staff trained each clinic to implement a postcard R&R system. Clinic staff was given an index box that contained monthly index tabs, postage-paid post cards, highlighter pens and a R&R reference manual

OBJECTIVE:
To assess whether providers who were previously trained in R&R were still using the system, and, if not, what barriers prevented providers from conducting R&R.

METHOD:
A survey was conducted among a randomly selected sample of 135 clinics that received R&R training. The survey instrument consisted of 17 questions and was administered by LACIP staff by telephone. During data analysis, we analyzed 4 main questions that identified provider reasons for conducting R&R.

RESULT:
Among 135 providers surveyed, 90% of respondents still employed an R&R system since they were trained over a year before. Of those clinics no longer using R&R, the two major reasons are a small pediatric population (30%) and insufficient number of staff (20%) to conduct R&R. Recently trained providers cited fewer problems in maintaining R&R system (8%) compared to providers trained more than a year ago (22%). Incomplete patient locating information was frequently cited as a barrier to effectively carry out a R&R program. Of providers using postcards/letters to remind patients to return, 50% or more of their patients were cited to return for appointments. Eighty-eight percent of clinics state they recall patients who missed a scheduled immunization appointment with the most commonly used method being the telephone.

CONCLUSION:
The majority of clinics surveyed still conduct R&R a year or more post-training despite difficulties with a transient population. Postcards/letters and telephone calls are effective R&R methods.

LEARNING OBJECTIVES:
To determine barriers and problems that prevents providers from implementing R&R.