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Impact of appointment reminders on vaccination coverage at an urban clinic
M M Irigoyen1, S Findley, B Earle
1Division of General Pediatrics, College of Physicians and Surgeons. mi5@columbia.edu
Insights
Appointment reminders, even when unaware of immunization status, significantly boost appointment adherence and vaccination coverage. This cost-effective strategy ensures more children receive timely immunizations.
Area of Science:
- Pediatric Health
- Public Health Interventions
- Health Services Research
Background:
- Low vaccination coverage rates remain a significant public health concern.
- Effective strategies are needed to improve appointment adherence and immunization rates, particularly in underserved communities.
- Appointment reminders have shown potential but their impact when blinded to immunization status requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of blinded appointment reminders in improving kept-appointment rates.
- To assess the impact of these reminders on vaccination coverage.
- To determine the cost-effectiveness of different reminder methods.
Main Methods:
- A controlled trial was conducted in a pediatric clinic serving a low-income community.
- 1273 children aged 4-18 months were randomized into four groups: control, postcard reminders, telephone reminders, and combined postcard and telephone reminders.
- Kept-appointment rates and vaccination coverage were the primary outcome measures.
Main Results:
- Children receiving combined postcard and telephone reminders were 1.75 times more likely to keep appointments.
- Those who received reminders and kept appointments were 2.3 times more likely to be up-to-date with immunizations.
- The strategy was cost-effective, with postcard reminders costing $0.67 and combined reminders $1.58, yielding significant returns on investment.
Conclusions:
- Blinded appointment reminders are a practical and cost-effective method to increase appointment keeping.
- This approach effectively improves vaccination coverage by reaching children who are not up-to-date.
- The findings support the implementation of blinded reminders in pediatric settings to enhance immunization rates.
Objective:
To test if appointment reminders blinded to immunization status improve kept-appointment and vaccination coverage rates. Design. Controlled trial.
Setting:
Pediatric clinic serving a low-income community in New York City.
Intervention:
Children ages 4 through 18 months (n = 1273) scheduled sequentially for clinic appointments were systematically assigned to 1 of 4 study groups: control (n = 346); postcard (n = 314); telephone call (n = 307); and postcard and telephone call (n = 306).
Outcome Measures:
Kept-appointment and vaccination coverage rates.
Results:
Children assigned to the postcard and telephone group were 1.75 times more likely to keep their appointments than controls (95% confidence interval [CI] = 1.2, 2.5). Children who actually received the postcard and telephone reminders were 2.3 times more likely to keep an appointment than controls (95% CI = 1.4, 3.7). Children who kept appointments were 2.3 times more likely to be up-to-date with their immunizations (95% CI = 1.7, 3.2). The reminders selectively increased vaccination coverage for the subgroup of children who were not up-to-date before the appointment (chi(2) = 11.2). The cost of the reminders was $.67 for the postcard and $1.58 for the postcard and telephone. Assuming 5000 visits per year and $100 reimbursement per visit, the return on each dollar invested was $10 for the postcard and $7.28 for the postcard and telephone reminder.
Conclusions:
Appointment reminders blind to immunization status are a practical and cost-effective strategy to increase kept-appointment rates for all children, and, through this mechanism, reach and vaccinate children who are not up-to-date.appointment reminder, vaccination coverage.