Vaccination is recognized as one of the greatest public health achievements of the 20th century. Notably, incidence of major childhood infectious diseases has declined by 98% since childhood immunizations began.
However, only 68% of children aged 19-35 months receive all recommended vaccines in 2012. A Healthy People 2020 goal is to increase the proportion of children aged 19-35 months who receive all recommended doses of childhood vaccines to 80%
The Community Preventive Services Task Force recommends the use of reminder/recall for increasing immunization rates. Reminder/recall consists of: notification for upcoming immunizations (reminders) and recall notices for overdue immunizations (recall).
Practice-based reminder/recall has been proven efficacious in multiple RCTs; however, few providers are conducting reminder/recall for immunizations.
An alternative public-health based approach working in collaboration with regional or state immunization information systems can facilitate reminder/recall because such systems can identify children who need immunizations and generate reminder postcards or electronic data for centralized messaging.
The MOHR study shows how a participatory design can be used to promote the consistent collection and use of patient-reported health behavior and psychosocial assessments in a broad range of primary care settings. While pragmatic in nature, the study design will allow valid comparisons to answer the posed research question, and findings will be broadly generalizable to a range of primary care settings. Per the pragmatic explanatory continuum indicator summary (PRECIS) framework, the study design is substantially more pragmatic than other published trials. The methods and findings should be of interest to researchers, practitioners, and policy makers attempting to make healthcare more patient-centered and relevant.
Methods. This cluster-randomized trial involved children aged 19 to 35 months needing immunizations in 8 rural and 6 urban Colorado counties. In Pop-recall counties, recall was conducted centrally using the Colorado Immunization Information System (CIIS). In PCP-recall counties, practices were invited to attend webinar training using CIIS and offered financial support for mailings. The percentage of up-to-date (UTD) and vaccine documentation were compared 6 months after recall. A mixed-effects model assessed the association between intervention and whether a child became UTD.
Results. Ten of 195 practices (5%) implemented recall in PCP-recall counties. Among children needing immunizations, 18.7% became UTD in Pop-recall versus 12.8% in PCP-recall counties (P < .001); 31.8% had documented receipt of 1 or more vaccines in Pop-recall versus 22.6% in PCP-recall counties (P < .001). Relative risk estimates from multivariable modeling were 1.23 (95% confidence interval [CI] = 1.10, 1.37) for becoming UTD and 1.26 (95% CI = 1.15, 1.38) for receipt of any vaccine. Costs for Pop-recall versus PCP-recall were $215 versus $1981 per practice and $17 versus $62 per child brought UTD.
Conclusions. Population-based recall conducted centrally was more effective and cost-effective at increasing immunization rates in preschool children.
www.Precis-2.org