How Successful Is Reminder/Recall in Improving Immunization Rates for Adolescents in Pediatrics and Family Medicine Practices?

Background:
Although patient reminder/recall is effective at improving vaccination rates in young children, little is known about its effectiveness in adolescent populations.

Objectives:
To assess and compare the effectiveness of reminder/recall for adolescents in pediatric (Peds) and family medicine (FM) practices.

Methods:
Randomized controlled trial of reminder/recall in four Peds and three FM private practices in Denver, CO. In each site, 300-400 adolescents 11-18 years who had not received Tdap, MCV4 or at least one HPV4 vaccine (females only), were randomly selected and randomized to intervention (2 letters and 2 telephone calls) or control (usual care) groups. Primary outcomes were proportion receiving at least one needed vaccine and proportion that were up-to-date (UTD) for Tdap and MCV4 and (for females) had received at least one HPV4 six months after reminder/recall.

Results:
Overall, intervention subjects were significantly more likely than controls to receive a vaccine in both types of practice settings [Peds OR=1.78 (1.44, 2.19); FM OR=1.79 (1.35, 2.37)]. Significant increases between intervention and control in proportion receiving at least one vaccine were observed in three of four Peds practices (15-22% absolute increase in percentage points) and all FM practices (9-12% increase). Adolescents in the intervention group were also more likely than controls to be UTD for Tdap and MCV4 and to have received 1 HPV4 (females only) in both practice settings [Peds OR=1.74 (1.39, 2.19); FM OR=1.76 (1.20, 2.57)]. Significant increases in combined rates were again observed in three of four Peds practices (9-16% absolute increase in rates) and in one of three FM practices (9% increase). Intervention success did not differ significantly by type of site (p=0.41 for practice type by intervention interaction).

Conclusions:
Reminder/recall was successful at increasing vaccination rates in adolescents in all settings, and effect sizes were comparable to those reported for reminder/recall in younger children.