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

Background: Reminder/recall has been demonstrated to be effective in increasing immunization rates in urban pediatrics and family medicine practices. Little is known about its effectiveness for adolescents in rural areas, where immunization delivery practices may differ substantially.

Objectives: To assess the effectiveness of reminder/recall for adolescents in rural family medicine (FM) practices and the proportion of immunizations given by public health departments.

Methods: Randomized controlled trial performed of reminder/recall in 4 FM sites in rural Colorado. Adolescents 11-18 years old who needed Tdap, MCV4 or the first dose of HPV (females only), were randomized to intervention (2 letters and 2 telephone calls) or control (usual care) groups. Primary outcomes were receipt of least one needed vaccine and receipt of all (Tdap, MCV4, and first HPV [females only]) needed vaccines six months after reminder/recall. 

Results: There were 1110 subjects included in the study. Intervention subjects were more likely than controls to receive at least one vaccine (19% vs. 13%, p<0.01) and all needed vaccines (9% vs.5%, p<0.01). Higher rates of receiving MCV4 were observed in the intervention than control group (11% vs.5%, p<0.01). Rates did not differ for Tdap (22% vs.16%, p=.06) and first HPV (9% vs. 6%, p=.17 [females only]). Of the immunizations given to study subjects in the six-month follow up period, the proportion of immunizations given by public health departments for each of the 4 practices were 17%, 43%, 73% and 80%.

Conclusions: While reminder/recall increased adolescent immunization rates, the effects were modest and rates remained low. Not all adolescents who responded to the recall received all required vaccines, indicating missed opportunities. Many adolescents recalled by their practice received vaccines from public health departments. In rural areas where most immunizations are given in a public health setting, centralized reminder/recall through public health departments may be more effective than practice based recall.