Effectiveness of Immunization Reminder/Recall Program in a Highly Transient Community

Background:
Client reminder/recall has been a proven effective intervention to increase immunization rates. In 2006, Nevada ranked lowest in childhood immunization rates at 59.5% for the 4:3:1:3:3:1 vaccines. One commonly given reason is the transient nature of the community. This study aimed to determine the effectiveness of the reminder/recalls in a highly transient community.

Setting:
A medical school outpatient clinic in Las Vegas, Nevada.

Population:
12 and 18 month old active patients of the clinic.

Project Description:
From December 2007 - June 2008, charts were reviewed and postcard reminders were sent to patients 1 month before they turned 12 and 18 months. A postcard recall (first recall) was sent 1 month following the scheduled 12 and 18 month well check visit to patients who missed the appointment. A phone recall (second recall) was made 2 months after the scheduled 12 and 18 month well check visit to patients who missed their initial appointment and did not respond to the postcard recall. During phone recalls, patients were asked if they received the postcard reminder/recall and if they received immunization at another location.

Results/Lessons Learned:
607 reminders were sent to patients who turned 12 and 18 months during the study period. 91% (551/607) received the reminders and 16.2% (89/551) responded by receiving immunization. 474 received a postcard recall and 11.8% (56/474) responded. 305 received phone recalls and 9.8% (30/305) responded. 46 (7.6%) patients who received the reminder responded by getting immunized at another healthcare facility. Overall, 40% (221/551) of patients who received an initial reminder received immunization. There was a statistically significant trend in the cumulative percentage of patients responding to the postcard:χ² ₍₁₎=60.72,p<0.005. An immunization reminder/recall program appears effective even in a transient community. A single reminder appears to be a more efficient method compared to recalls (postcard or phone) in improving immunization rates in our highly transient populations.