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PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1076-1082

Adoption of Reminder and Recall Messages for Immunizations by Pediatricians and Public Health Clinics

Cheryl D. Tierney, MD, MPH^*, Hussain Yusuf, MBBS, MPH, Shawn R. McMahon, MD, MPH, Donna Rusinak, BS, Megan A. O’ Brien, MPH, Mehran S. Massoudi, PhD, MPH and Tracy A. Lieu, MD, MPH^,||

^* Harvard Combined Pediatric Health Services Research Fellowship Program, Boston, Massachusetts
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Center for Child Healthcare Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Healthcare and Harvard Medical School
^|| Division of General Pediatrics, Children’s Hospital, Boston, Massachusetts

Objective. Strong scientific evidence and national recommendations support the use of reminder and recall messages to improve immunization coverage rates, yet reports have suggested that only a minority of pediatric practices use such messages. Our aims were to 1) determine the proportions of pediatric practices and public clinics that currently use practice-based reminder or recall messages and routinely undergo immunization assessment efforts, 2) evaluate barriers and supports to implementing these practices, and 3) identify predictors of either current use or plans for future adoption of these practices.

Methods. This study combined qualitative and quantitative methods in sequential phases. In the qualitative phase, we conducted semistructured, open-ended interviews with a convenience sample of 18 clinician-administrators representing adopters and nonadopters of these messages in both private practices and public health clinics. In the subsequent quantitative phase, we mailed a structured, closed-ended survey to national samples of randomly selected pediatricians (n = 600) and public clinics (n = 600).

Results. Response rates were 75% for pediatricians and 77% for public clinics. Among pediatricians, 38% were conducting regular assessments of immunization coverage but only 16% were currently using routine reminder or recall messages. Among public clinics, 85% were conducting regular assessments and 51% were using reminder or recall messages. Among pediatricians’ practices, the most commonly reported barriers to the adoption of reminder or recall messages were lack of time and funding and the inability to identify children at specified ages. For pediatricians’ practices, the strongest predictors of current use of reminder or recall messages were having a champion who led efforts to improve immunization delivery (odds ratio: 1.85; 95% confidence interval: 1.08–3.18) and current use of regular immunization assessments (odds ratio: 2.30; 95% confidence interval: 1.33–3.84). Likewise, for public health clinics, having a champion to lead immunization improvement efforts and believing that their current system needed improvement was associated with current use of reminder or recall messages.

Conclusions. Reminder and recall messages remain underused by both pediatricians and public health clinics. Promising strategies to promote adoption of these approaches in both the private and the public sectors include identifying and training champions to promote immunization delivery improvement efforts and helping practices develop methods to identify children at specific ages.

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Key Words: immunizations • interventions • quality of care • recall • reminder • assessment

Abbreviations: OR, odds ratio • CI, confidence interval

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Received for publication Oct 23, 2002; Accepted Apr 24, 2003.

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