Reminders for childhood immunizations are slightly more successful and cost-effective when sent from county health departments with a child’s primary care provider’s endorsement than when sent only from the practices themselves, according to a recent study.
“The effect sizes seen in the present trial, although modest, are important from a public health perspective,” Dr. Allison Kempe of Children’s Hospital Colorado, Aurora, and her associates reported online.
Dr. Allison Kempe
“Our findings and those of previous studies support consideration of a centralized collaborative, compared with a practice-based reminder/recall approach to increase immunization rates during the preschool years,” they said. “The present trial demonstrates the poor reach of a practice-based approach from the population perspective,” (JAMA Pediatr. 2015 Feb. 23 [doi:10.1001/jamapediatrics.2014.3670]).
The researchers randomized 15 Colorado counties to implement one of two immunization reminder approaches for the 18,235 children, aged 19-35 months as of Sept. 7, 2012, through March 17, 2013. In the centralized collaborative approach, county health departments mailed and/or autodialed immunization reminders up to four times per child, with the option for primary care providers to add their names to the message. In the practice-based approach, individual practices were invited up to eight times to a Web-based reminder training and received financial support for sending notifications. Only two practices sent reminder/recall notifications in the practice-based counties, but 56.3% of practices added their name to reminders in centralized-collaborative counties.
In the collaborative counties, 87% of eligible children received at least one reminder, compared with just 0.8% in the practice-only counties. In the collaborative counties, 26.9% of children received at least one new immunization, and 12.8% of children became up to date in immunizations, compared with 21.7% and 9.3%, respectively, in practice-based counties. In collaborative counties, 32.1% of children came in for an immunization and 19.2% reached up-to-date status when the health department message included the child’s primary care provider’s name, compared with 24.2% and 9.5% of children, respectively, when the practice name was left off.
The cost of a centralized collaborative reminder system was $11.75 per child for any new immunization and $24.72 for reaching up-to-date status, compared with $74 and $124.45 per child, respectively, in practice-based counties. Each mail contact cost an average $0.73, and each autodial cost an average $0.53. No difference was seen between mailed vs. called reminders. “However, costs would have been much lower if the accuracy of all contact data could be increased,” the researchers noted.
The research was funded by the Agency for Healthcare Research and Quality. The authors reported no relevant financial disclosures.