Elsevier

The Journal of Pediatrics

Volume 139, Issue 5, November 2001, Pages 630-635
The Journal of Pediatrics

Original Articles
Immunization recall: Effectiveness and barriers to success in an urban teaching clinic,☆☆

https://doi.org/10.1067/mpd.2001.117069Get rights and content

Abstract

Objective: To examine effectiveness of immunization recall in an urban pediatric teaching clinic and to identify barriers to recall effectiveness. Design: Randomized, controlled trial. Children aged 5 to 17 months who were not up to date (UTD) with recommended immunizations were identified and assigned to intervention (n = 294) or control groups (n = 309). The intervention consisted of a mailed postcard and up to 4 telephone calls. Two months after intervention, UTD status, visit, and probable missed opportunity rates were assessed. Results: Of the intervention group, 30% could not be reached. In 12-month-old children in the intervention group compared with those in the control group, there was a trend toward higher UTD rates (51% vs 39%, P =.07) and a higher proportion of UTD children receiving immunizations as opposed to getting more complete documentation (25% vs 10%, P =.005). Similar differences between intervention and control children were not seen in the 7-month and 19-month age categories. More children in the intervention group had a health maintenance visit (17% vs 11%, P =.03). Of children in the intervention group who were seen when not UTD, 17 of 24 (71%) of those seen for an illness visit and 5 of 24 (21%) of those seen for health maintenance probably had missed opportunities to be immunized. Conclusions: Recall efforts were partially successful but were undermined by inability to reach the clinic population, poor documentation of immunizations, and missed opportunities. (J Pediatr 2001;139:630–5)

Section snippets

Methods

The study was conducted from January through July 1999 in the outpatient pediatric clinic at The Children’s Hospital, an urban teaching hospital in Denver, Colorado. The study protocol was reviewed and approved by the institutional review board. The clinic serves primarily low-income families, of whom 63% are covered by Medicaid or a state-subsidized insurance program, 21% have commercial insurance, and 16% are uninsured. The clinic population is highly transient, with at least 50% of families

Results

The intervention and control groups were similar with respect to demographic and utilization variables (Table I).

. Characteristics of study populations

VariableIntervention group (n = 292)Control group (n = 304)P value
Race/ethnic group [No. (%)]
 African American28 (13)29 (13)
 White44 (20)44 (20)
 Hispanic70 (32)64 (28)
 Unknown66 (30)81 (36)
 Other10 (5)7 (3).69
Sex [No. (%)]
 F98 (48)105 (48).99
Mean age in months (SD)11.7 (3.0)11.8 (3.1).77
Proportion with well-child visits at TCH [No. (%)]226 (77)233 (77).83

Discussion

Recall of children not UTD with immunizations has been shown to increase immunization rates in a number of studies3, 4, 5, 6, 7, 8 and can have ancillary benefits of increasing health supervision visits and screening rates.3 On the basis of such data, the 1993 Standards for Immunization Practice and a 1999 consensus statement by the National Vaccine Advisory Committee recommend that all immunization providers should operate recall and reminder systems.1, 22 Attempts to carry out this

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  • Cited by (0)

    Supported by a grant from the Centers for Disease Control and Prevention.

    ☆☆

    Reprint requests: Allison Kempe, MD, MPH, The Children’s Hospital, 1056 E 19th Ave, B032, Denver, CO 80218.

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