In the Journals

Patient reminders improve child, teen, adult vaccination rates

Julie C. Jacobson Vann

The use of patient recalls and reminders for childhood, adolescent and adult vaccinations — including telephone calls, postcards and text messages —improves vaccination rates within all age groups, according to findings published in the Cochrane Library.

“The evidence shows that reminding people to have vaccinations increases the number of people who receive vaccinations,” Julie C. Jacobson Vann, PhD, MS, RN, from The University of North Carolina at Chapel Hill School of Nursing, said in a press release. “All types of patient reminder and recall are likely to be effective, and reminding people over the telephone was most effective. Even a small effect of patient reminders and recalls, when scaled to a whole population, could have a large beneficial effect on public health.”

To analyze the efficacy of different patient reminder and recall interventions for improving immunization rates, the researchers gathered information from CENTRAL, MEDLINE, Embase and CINAHL until January 2017. Additionally, the researchers searched gray literature and trial registers within this time.

Of the studies included in this analysis, randomized trials, controlled before and after studies and interrupted time series assessing patient reminders for immunization or recall interventions in children, teenagers and adults were included, regardless of the setting in which the vaccine was administered. Furthermore, Jacobson Vann and colleagues encompassed no-intervention control groups, standard practices that did not include vaccination reminders and recalls, use of media that endorses immunization and awareness campaigns.

The researchers aimed to assess any record of immunization; however, Jacobson Vann and colleagues did not include special travel immunizations or patients who were hospitalized throughout the study period.

Of the 75 studies that the researchers included, children, adolescents and adults were represented. Vaccinations were received within 10 countries at various locations, including outpatient, community-based, primary care and other locations.

The use of interventions such as telephone and autodialer calls, letters, postcards, text messages, combinations of mail and telephones or a combination of patient reminder or recall in addition to outreach are likely to be effective in improving immunization rates (RR = 1.28; 95% CI, 1.23-1.35; risk difference = 8%). These data demonstrated a moderate certainty within 55 studies that included 138,625 patients.

Of these reminders and recalls, postcards (RR = 1.18; 95% CI, 1.08-1.30; eight studies with 27,734 participants), text messages (RR = 1.229; 95% CI, 1.15-1.44; six studies with 7,772 participants) and autodialer (RR = 1.17; 95% CI, 1.03-1.32; five studies with 11,947 participants) were effective with high certainty evidence. Telephone calls (RR = 1.75; 95% CI, 1.20-2.54; seven studies with 9,120 participants) and letters to patients (RR = 1.29; 95% CI, 1.21-1.38; 27 studies with 81,100 participants) were determined to probably improve rates of immunization.

The use of reminders was effective in improving both childhood vaccination rates (RR = 1.22; 95% CI, 1.15-1.29; risk difference = 8%; 23 studies with 31,099 participants) and adolescent vaccination rates (RR = 1.29; 95% CI, 1.17-1.42; risk difference = 7%; 10 studies with 30,868 participants). Specifically, the researchers determined that these reminders probably improve rates of vaccination against childhood influenza (RR = 1.51; 95% CI, 1.14-1.99; risk difference = 22%; five studies with 9,265 participants) and adult influenza (RR = 1.29; 95% CI, 1.17-1.43; risk difference = 9%; 15 studies with 59,328 participants).

Other vaccinations for adults, including pneumococcus, tetanus, hepatitis B and other noninfluenza immunizations, improved with low-certainty evidence (RR = 2.08; 95% CI, 0.91-4.78; four studies with 8,065 participants).

“We have the technology to incorporate patient reminders and recall into routine primary care,” Jacobson Vann said in the release. “Reminder and recall systems need to be tailored to each health service setting to maximize their effectiveness. For example, person-to-person telephone reminders are effective, but they may also be more costly than other methods.”

“As technologies develop, we need to consider how they can enhance reminder and recall interventions,” she continued. “For example, we need to learn more about the characteristics of the most effective centralized and text message interventions.” – by Katherine Bortz

Disclosures: Jacobson Vann reports no relevant financial disclosures. Please see the study for a full list of the other authors’ relevant financial disclosures.

Julie C. Jacobson Vann

The use of patient recalls and reminders for childhood, adolescent and adult vaccinations — including telephone calls, postcards and text messages —improves vaccination rates within all age groups, according to findings published in the Cochrane Library.

“The evidence shows that reminding people to have vaccinations increases the number of people who receive vaccinations,” Julie C. Jacobson Vann, PhD, MS, RN, from The University of North Carolina at Chapel Hill School of Nursing, said in a press release. “All types of patient reminder and recall are likely to be effective, and reminding people over the telephone was most effective. Even a small effect of patient reminders and recalls, when scaled to a whole population, could have a large beneficial effect on public health.”

To analyze the efficacy of different patient reminder and recall interventions for improving immunization rates, the researchers gathered information from CENTRAL, MEDLINE, Embase and CINAHL until January 2017. Additionally, the researchers searched gray literature and trial registers within this time.

Of the studies included in this analysis, randomized trials, controlled before and after studies and interrupted time series assessing patient reminders for immunization or recall interventions in children, teenagers and adults were included, regardless of the setting in which the vaccine was administered. Furthermore, Jacobson Vann and colleagues encompassed no-intervention control groups, standard practices that did not include vaccination reminders and recalls, use of media that endorses immunization and awareness campaigns.

The researchers aimed to assess any record of immunization; however, Jacobson Vann and colleagues did not include special travel immunizations or patients who were hospitalized throughout the study period.

Of the 75 studies that the researchers included, children, adolescents and adults were represented. Vaccinations were received within 10 countries at various locations, including outpatient, community-based, primary care and other locations.

The use of interventions such as telephone and autodialer calls, letters, postcards, text messages, combinations of mail and telephones or a combination of patient reminder or recall in addition to outreach are likely to be effective in improving immunization rates (RR = 1.28; 95% CI, 1.23-1.35; risk difference = 8%). These data demonstrated a moderate certainty within 55 studies that included 138,625 patients.

Of these reminders and recalls, postcards (RR = 1.18; 95% CI, 1.08-1.30; eight studies with 27,734 participants), text messages (RR = 1.229; 95% CI, 1.15-1.44; six studies with 7,772 participants) and autodialer (RR = 1.17; 95% CI, 1.03-1.32; five studies with 11,947 participants) were effective with high certainty evidence. Telephone calls (RR = 1.75; 95% CI, 1.20-2.54; seven studies with 9,120 participants) and letters to patients (RR = 1.29; 95% CI, 1.21-1.38; 27 studies with 81,100 participants) were determined to probably improve rates of immunization.

The use of reminders was effective in improving both childhood vaccination rates (RR = 1.22; 95% CI, 1.15-1.29; risk difference = 8%; 23 studies with 31,099 participants) and adolescent vaccination rates (RR = 1.29; 95% CI, 1.17-1.42; risk difference = 7%; 10 studies with 30,868 participants). Specifically, the researchers determined that these reminders probably improve rates of vaccination against childhood influenza (RR = 1.51; 95% CI, 1.14-1.99; risk difference = 22%; five studies with 9,265 participants) and adult influenza (RR = 1.29; 95% CI, 1.17-1.43; risk difference = 9%; 15 studies with 59,328 participants).

Other vaccinations for adults, including pneumococcus, tetanus, hepatitis B and other noninfluenza immunizations, improved with low-certainty evidence (RR = 2.08; 95% CI, 0.91-4.78; four studies with 8,065 participants).

“We have the technology to incorporate patient reminders and recall into routine primary care,” Jacobson Vann said in the release. “Reminder and recall systems need to be tailored to each health service setting to maximize their effectiveness. For example, person-to-person telephone reminders are effective, but they may also be more costly than other methods.”

“As technologies develop, we need to consider how they can enhance reminder and recall interventions,” she continued. “For example, we need to learn more about the characteristics of the most effective centralized and text message interventions.” – by Katherine Bortz

Disclosures: Jacobson Vann reports no relevant financial disclosures. Please see the study for a full list of the other authors’ relevant financial disclosures.