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From the Centers for Disease Control and Prevention
September 23/30, 1998

Recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians: Use of Reminder and Recall by Vaccination Providers to Increase Vaccination Rates

Author Affiliations

Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998American Medical AssociationThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

JAMA. 1998;280(12):1043. doi:10.1001/jama.280.12.1043-JWR0923-2-1

MMWR. 1998;47:715-717

THIS STATEMENT by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) presents and recommends a programmatic strategy—the use of a reminder and/or recall (R/R) system by vaccination providers—to increase vaccination rates. In 1992, a national survey indicated that 8% of pediatricians and 5% of family physicians had implemented a manual vaccination R/R system and 6% and 5%, respectively, used a computer-based system for vaccination R/R messages.1 In 1993, the National Vaccine Advisory Committee issued the "Standards for Pediatric Immunization Practices," which recommend that all public and private health-care providers use a vaccination R/R system.2 These standards were endorsed by ACIP, AAP, and AAFP. By 1995 a survey indicated that R/R systems were used by 35% of pediatricians and 23% of family physicians (R. Zimmerman, University of Pittsburgh School of Medicine, personal communication, 1995).

The reminder component consists of mail and/or telephone messages to remind parents or guardians of vaccination due dates for their children. Reminder messages can improve parents' awareness that vaccinations are due and the importance of keeping appointments, therefore increasing the up-to-date vaccination status of children. The recall component consists of mail and/or telephone messages to parents or guardians of children who are past due for one or more vaccinations. Recall messages can decrease vaccination drop-out rates and reduce the time children remain at risk for vaccine-preventable diseases. R/R systems can be operated manually (e.g., by monthly tickler file) or can be automated (e.g., by computer-generated mailings or telephone calls). Messages from automated systems can be modified to address special needs (e.g., language).

The implementation of vaccination R/R systems has potential benefits beyond improved vaccination coverage rates. Patients of all ages who are due or overdue for recommended vaccinations also may have fallen behind in health supervision visits and may experience barriers to health care in general. Vaccination R/R systems may help identify patients who are at risk for not receiving comprehensive primary care. R/R systems also can be established independently for improving attendance for child health supervision visits and other recommended preventive health service visits, including adult vaccination,3 cervical cancer screening,4 and lead screening. The cost-effectiveness of R/R systems for a provider can be dependent on the number of patients, the documented level of vaccination coverage, the provider's level of computerization, and the intensity with which the provider uses the R/R system.5,6

Properly implemented, the R/R strategy contributes to high, sustainable vaccination coverage levels. Studies of the effectiveness of mail or telephone reminder messages generally have demonstrated improvements in patient compliance for a variety of scheduled health-care visits, including vaccinations.7-9 Among patients scheduled for a vaccination visit who received a single autodialer-based reminder call the night before a scheduled visit, attendance was 57% compared with 20% in the control group who received no reminder6; 41% of patients who received a vaccination R/R message visited the provider within 30 days compared with 28% of those who did not receive a reminder.10

The ACIP, AAFP, and AAP recommend the regular use of R/R systems by public and private health-care providers in settings that have not achieved high documented levels of age-appropriate vaccinations. For reminder systems, messages should be delivered close to the due date for vaccinations. In recall systems, messages should be delivered promptly if the scheduled visit is missed. Implementation of these recommendations can contribute substantially to improving vaccination coverage at the provider level.

Reported by:

Advisory Committee on Immunization Practices, Atlanta, Georgia. American Academy of Family Physicians, Kansas City, Missouri. American Academy of Pediatrics, Elk Grove Village, Illinois. Immunization Svcs Div, National Immunization Program, CDC.

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