Immunization Recall Implementation In Provider Offices

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Background: Recall programs increase childhood immunizations (IM). Arkansas has a mandatory state IM registry with limited use for recall.

Setting: Primarily rural setting

Population: Primary care physicians (PCP), one per practice setting. 

Project Description: Objective was to assess whether an office based recall system, promoted with academic detailers, could be implemented in a cost sustainable manner vs. outsourced recall system or no intervention. The study required weekly recall attempts and parent specified recall communication (e.g. mail, telephone, text, etc). Single physicians from practices in Arkansas were recruited and randomized. Outcomes:  PCP drop out; IM rates for 7-12 m. and 19-24 m.  children from each practice prior to enrollment and at the end of the 2 y;  PCP attitudes and practice patterns at the beginning and end of the study; costs for implementing recall.

Results/Lessons Learned: Four months of the intervention are complete with 98 physicians recruited. Fourteen % used some reminder/recall method for IM and 28% for well child visits; 67% immunized in their offices; 52% participated in the VFC program; 42% used an EHR; 69% used the state registry. Parent preferences for recall were 1rst by mobile phone (not by text) 2nd by land line. Among PCPs, 68% believed public insurance covered the costs of IM vs 51% for private; 73% PCPs believed that it was the doctors' responsibility for ensuring child IM; 80% believed recalls help improve IM rates: half believed recall could be done at a neutral cost. To date 8 physicians dropped out equally in the 3 groups. The remaining practices seem to have adapted to the procedures at this time.  Adoption of recall has been excellent but has required office system reformatting for many practices. Academic detailers have been helpful in overcoming hesitancy and providing technical assistance.