This month, ALERT IIS reached another milestone when it kicked off statewide recall for 22 month olds. “Oftentimes parents simply don’t know that their child is past due for immunizations,” said Mary Beth Kurilo, Director of ALERT IIS. “Reminding parents that immunizations are needed through recall is a proven strategy to improve immunization coverage.”
ALERT IIS will send notices each month to the parents or guardians of 22 month olds who are past due for immunizations. Some significant improvements have been made over ALERT’s previous statewide recall process. First, clinics now receive their list of 22 month olds who need immunizations through ALERT IIS. There’s less paper to shuffle, and it’s easy for staff to make corrections to records directly in ALERT IIS. Second, ALERT IIS now sends a letter to parents or guardians with their child’s immunization record and a list of which specific vaccines are needed, instead of a generic postcard to all parents.
Below are answers to common questions about reminder/recall, and steps you can take within your own clinic to improve immunization coverage through reminder/recall.
What is reminder/recall?
Notifying patients that immunizations are due (reminder) or past due (recall). Reminder/recall can occur at the state level, like ALERT IIS’s 22 month recalls, or at the individual clinic level. ALERT IIS has many tools available to providers who want to do reminder/recall.
Typically, clinics that conduct reminder/recall target a segment of their patient population with lower immunization rates. For example, clinics may opt to conduct reminder/recall for adolescents who have not completed the HPV series, or kindergartners who are missing a second dose of MMR. These clinics use ALERT IIS or their electronic health record (EHR) to create a list of patients who are due or past due. These patients are then contacted and encouraged to schedule an appointment to be immunized. Clinics can choose to contact patients by telephone, letter, email, or text message – whatever makes the most sense for the clinic and its patients.
Why is reminder/recall important?
Oftentimes patients simply don’t know that they need immunizations. Reminder/recall makes them aware, and provides them with information about where to go to receive immunizations.
Since 1997, many studies have demonstrated the impact of clinic-based reminder/recall. Reminder/recall improves immunization coverage for children, adolescents, or adults, and across a wide span of clinical settings[i].
Also, doing reminder/recall for immunizations is a great way to identify patients who need to come in for well child visits or other services[ii].
If the state immunization program does recall, should my clinic do reminder/recall on its own?
The ALERT IIS statewide recall only catches 22 month olds who are not up-to-date on immunizations.
You can conduct reminder/recalls for any segment of your patient population – 18 month olds who have not received a 4th DTaP, 13 year olds who need a meningococcal vaccine, or adults who have only received one dose of hepatitis A. And you can choose the reminder/recall schedule for your clinic that makes the most sense. While monthly notices are great, your clinic may opt to send notices quarterly, or even just a couple times each year. The possibilities are endless.
Can you tell us about a clinic in Oregon that has successfully used reminder/recall to improve immunization rates?
The quiet, historic town of Dallas, Oregon is nestled amidst the vineyards and wineries of the Willamette Valley. Dallas Family Medicine has been providing primary care services to the community for more than 60 years.
Dallas Family Medicine has used a recall system for many years, sending post card reminders to patients. Under HIPAA laws, Dallas Family Medicine staff could no longer send specific patient information on a post card, and they found their system to be less effective than in the past.
Faith Shinn, an RN who has worked at Dallas Family Medicine for over 22 years, recently decided to attend a webinar to learn about the ALERT IIS reminder/recall system.
“After attending the webinar,” said Shinn, “I realized that our adolescents were falling through the cracks.” Faith worked with ALERT IIS staff to run a reminder/recall report on her adolescent patients and to send out letters with their immunization history and needed immunizations.
Dallas Family Medicine took the opportunity to also recommend an adolescent well visit for these patients. As Faith explained, many of these patients hadn’t been seen in many years because they were generally healthy, and parents sometimes forget that well visits are due.
Approximately 30 percent of the adolescents who received a reminder/recall notice scheduled an appointment for immunizations and a well visit. “This was a huge success for our clinic,” said Shinn. “Many of these patients had a well visit, and many are now completely up-to-date on recommended vaccinations.”
The staff at Dallas Family Medicine are keeping the momentum going by using a new software program to recall children and adolescents, along with the ALERT IIS 22 month recall and their postcard system. Said Shinn, “Immunization status is used for benchmarking and reporting, but most importantly to keep our kids healthy. A good recall system is imperative to keeping our kids and families immunized.”
Kudos to the staff at Dallas Family Medicine! We appreciate all you do to keep your patients and community healthy.
Do you have resources to help?
ALERT IIS routinely offers reminder/recall webinars to train clinic staff on how to use these reports in ALERT. Sign up for a webinar at: http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/alert/Pages/Reports-Training.aspx
Interested in conducting reminder/recall for your adolescent patients? Oregon Immunization Program is currently conducting a special project to support clinics doing adolescent reminder/recall. And, even better, by participating in this project, we’ll help cover the cost of postage for reminder/recall letters sent to your patients.
Or, contact your Oregon immunization program health educator. They can help you identify patient populations within your clinic with lower immunization rates, generate reminder/recall reports in ALERT IIS, and develop workflows for how to integrate reminder/recall into your day-to-day work.
Interested in the research? Check out the Guide to Community Preventive Services at: http://www.thecommunityguide.org/vaccines/clientreminder.html
[i] The Guide to Community Preventive Services, Increasing Appropriate Vaccination: Client Reminder and Recall Systems, http://www.thecommunityguide.org/vaccines/clientreminder.html, (December 24, 2013).
[ii] Christina A. Suh, Alison Saville, Matthew F. Daley, Judith E. Glazner, Jennifer barrow, Shannon Stokley, Fran Dong, Brenda Beaty, L. Miriam Dickinson, and Allison Kempe, Effectiveness and Net Cost of Reminder/Recall for Adolescent Immunizations, Pediatrics, http://pediatrics.aappublications.org/content/early/2012/05/02/peds.2011-1714.full.pdf+html (December 24, 2013).