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A research team from University of Rochester and Centers for Disease Control and Prevention conducted a study which showed that telephone reminders had a limited impact on urban adolescents’ rates of immunization and health care visits.
Intervention participants were 11 to 14 years of age, including 1,496 study group adolescents and 1,510 control group adolescents. The study was carried out at two urban private practices, a hospital-based clinic and a neighborhood health center in Rochester, NY. Researchers used autodialer, an automated telephone message reminder system to contact study group adolescents in need of a tetanus booster (Td), a hepatitis B vaccination (3 doses) or an annual well-child care (WCC) visit.
“The impact of telephone reminders diminished over the study period; little benefit was found for WCC visits after 2 months or for vaccinations after 4 months.”
Telephone reminders were discontinued if the phone numbers were inaccurate, “the adolescent had left the practice, or the parents requested calls to be stopped.” In addition, telephone reminders were temporarily suspended if phone numbers were “unresponsive” (no scheduled health care visit following 5 calls within 30 days).
At the start of the intervention, study and control adolescents had similar rates of hepatitis B vaccination (45.1% vs. 44.0%), Td vaccination (24.7% and 23.8%), and WCC visits (52.3% vs. 54.2%). By the end of the intervention, study and control groups still had analogous rates of Td vaccination (52.0% vs. 49.9%) and WCC visits (53.1% vs. 54.3%). However, hepatitis B vaccination was slightly higher among the study group (62.0%) compared to the control group (57.8%). The rates of hepatitis B immunization appeared significantly different, but when researchers took into account the fact that some participants were ineligible for vaccinations, the results were no longer significant.
The study showed that the impact of telephone reminders did not vary based on participants’ age, race/ethnicity or insurance. The researchers also found that the impact of telephone reminders diminished over the study period; little benefit was found for WCC visits after 2 months or for vaccinations after 4 months.
However, adolescents whose telephone numbers changed were less likely to receive immunizations or health care visits than families with a single phone number. Over the course of the study, 69% of the study group had multiple telephone numbers. Those with multiple numbers were significantly less likely to have a WCC visit (25%) than those with a single number (71%). Differences in hepatitis B vaccinations were also significant.
“Those with multiple numbers were significantly less likely to have a WCC visit (25%) than those with a single number (71%).”
The researchers suggested that patient phone numbers and immunization records be updated at all health care visits. They also recommended collecting alternate telephone numbers when possible. Finally, the authors suggested that given the declining impact of the reminders over the course of the study, urban adolescents might benefit from a more concise intervention.
The authors concluded that “with emerging new adolescent vaccines, aggressive strategies will be needed to ensure high adolescent vaccination coverage as well as receipt of preventative adolescent services.”
Source: Szilagyi, Peter G., et al., Effect of Telephone Reminder/Recall on Adolescent Immunization and Preventive Visits, Archives of Pediatrics and Adolescent Medicine. Vol. 160, Pgs. 157-163.
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