Over 12 months, an immunisation navigator programme for urban adolescents increased immunisation rates by approximately 13% compared with control
- Correspondence to Regena Spratling
Department of Nursing, North Georgia College and State University, Health & Natural Sciences Building, Dahlonega, Georgia 30597, USA;
Implications for Nursing Practice and Research
■ Interventions that include patient tracking, reminder/recall and home visits can improve adolescent immunisation rates and preventive care visit rates.
■ Implementation of interventions aimed at immunisations and preventive care are needed to enhance adolescent care.
■ Research in development and implementation of programmes on a local, regional and national level are needed to address adolescent immunisation rates and preventive care.
Interventions that increase adolescent immunisation rates and preventive care visits are needed. This is demonstrated by data relating to vaccination coverage in the USA for the meningococcus (62.7%), pertussis vaccine (68.7%) and papilloma virus (32%; three doses for adolescent females).1 Differing vaccination programs have been cited as a potential cause of suboptimal vaccination coverage in adolescents.1 There is limited data in the literature using interventions that target adolescent immunisation rates. However, these targeted interventions such as reminder/recall programmes, have been found to improve immunisation rates and may benefit overall health by increasing access to healthcare and preventive care services.2
The use of reminder/recall programmes have been recommended as an intervention to increase immunisation rates in adolescents.1 3 These programmes have been found to be effective in both increasing immunisation rates and preventive healthcare visits.4 The reminder/recall interventions typically include telephone and mail reminders. Studies on these programmes in urban paediatric populations have found mixed results, although the inclusion of outreach programs that include home visits have proven effective.4
Szilagyi et al conducted a randomised clinical trial of a tiered immunisation intervention in a population of adolescents. The study sampled adolescents of 11–15 years of age (n=7546) served by the public and private practices in an urban area of the USA. Adolescents were randomly assigned to an intervention or control group. The groups were comparable in regard to demographic characteristics, and baseline immunisation rates and preventive care visits. The intervention consisted of a tiered protocol: (1) patient tracking of immunisation status, (2) telephone and mail reminders and (3) home visits. The control group received standard care. The outcome measures were receipt of recommended immunisations after 11 years of age (meningococcus, pertussis and papilloma virus vaccines (girls)) and the receipt of an annual preventive care visit. The process and cost measures associated with the intervention were also assessed.
Immunisation rates at the end of the study were 12.1–15.8% higher in the intervention group in comparison with the control group (p<0.001). However, both the control and intervention groups noted gains in immunisation rates compared with study baseline. The total immunisation rates (meningococcal, pertussis and three papilloma virus (girls)) were found to be 44.7% (intervention) and 32.4% (control). The preventive care visit rates were 9.1% to 16.7% higher in the intervention group compared with the control group. The majority of the intervention group received telephone or email reminders (71%); home visits were conducted with 12% of the intervention group. The intervention cost was $3.81 per adolescent per month.
This study contributes to the literature on interventions to increase immunisation rates in the paediatric population and highlights the challenges that healthcare providers face in tracking immunisations and reminding families of the need for timely immunisations and preventive care visits. The study also highlights the relationship between immunisations and preventive care visits; the success of both is intertwined for adolescent healthcare.
Study strength is the population-based large sample of urban adolescents. The study also highlights a practice-based approach to interventions for immunisation rates. Study limitations are the inability to distinguish effectiveness among the various tiers, including reminders via telephone and mail and home visits. Also, the feasibility of home visits may not be realistic in day-to-day practice for providers although the low cost of the intervention may be cost effective.
From an evidence-based nursing perspective, this study demonstrates the effectiveness of interventions focused on adolescent immunisation rates and preventive care visits. The study also highlights the effect of interventions in urban paediatric populations from a variety of public and private practices.