Evaluation of Vaccination Reminder/Recall Systems for Adolescent Patients
Condition: Human Papilloma Virus (HPV); Tetanus-diphtheria-acellular Pertussis (Tdap); Meningococcal Infection; Varicella
MeSH terms: Diphtheria; Meningococcal Infections; Papilloma
Study type: Interventional

Summary: 
      A study team with extensive experience in immunization delivery research will evaluate the
      effectiveness of vaccination reminder/recall systems for adolescent patients in five types of
      clinical settings including: urban pediatric, urban family medicine and rural family medicine
      practices, public pediatric clinics, and school-based health centers. Randomized controlled
      trials of reminder/recall for adolescents will be conducted at each type of site, with
      randomization at the level of the patient.
    

Detailed description: 
      Although patient reminder/recall systems have been shown to be effective at improving
      vaccination coverage levels for infants and younger children, little is known about the
      effectiveness of such systems for increasing immunization rates in adolescent populations.
      The process of reminder/recall in adolescents, and vaccination of adolescents overall,
      presents particular challenges. Adolescents are less likely to routinely access health care
      compared to younger children and adults. In addition, other obstacles such as lack of health
      insurance, missed opportunities for vaccination during health care visits, and the scattering
      of immunization records across multiple providers have posed major challenges in the
      vaccination of adolescents. Issues of parental consent for vaccination can also be
      problematic, given that adolescents may present for care without their parents accompanying
      them. These and other barriers to immunization may reduce the effectiveness of
      reminder/recall for adolescents. In the current research study, a study team with extensive
      experience in immunization delivery research will investigate the ability of pediatricians
      and family physicians in a number of different practice settings to implement a
      reminder/recall system for their adolescent patient populations. In addition, we will be able
      to examine the effectiveness of reminder/recall originating at public school-based health
      centers, an innovative strategy that has not previously been reported. Randomized controlled
      trials of reminder/recall for adolescents will be conducted at each type of site. The study
      team will track important process measures during reminder/recall including the percentage of
      the eligible population who actually received intervention; percentage with incorrect
      addresses; percentage with incorrect or disconnected phones; percentage actually up-to-date
      but incorrectly recalled; missed vaccination opportunities; and invalid doses of vaccines
      administered. In this way, we will be able to not only determine the degree to which
      reminder/recall was successful for adolescents, but also identify impediments to success,
      which will provide a foundation for future efforts. Our study will also investigate the cost
      of establishing and operating a reminder/recall system for adolescents in each type of
      clinical setting.

      Major Hypotheses

        1. Reminder/recall of adolescents will result in an increased rate of receipt of
           immunizations in private settings of approximately 10 percentage points

        2. Reminder/recall will result in a greater rate of receipt of immunizations when patients
           in public settings have access to a school-based health center (SBHC) compared to when
           they do not have access to a SBHC

        3. Reminder/recall originating at SBHC sites will result in the highest efficacy of
           reminder/recall among all the types of clinical sites
    

Intervention name(s): Reminder/recall notices for vaccines
Intervention type(s): Other
Intervention description(s): Receive a generic letter reminding them to make an appointment to get vaccines.
Receive a computer-generated telephone message at 1 week post initial letter.
Receive a computer-generated telephone message at 2 months post initial letter.
Receive a letter at 3 months post initial letter.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: adolescent reminder/recall; adolescent vaccines; Tdap; Meningococcal; HPV; Reminder cards; Recall messages; vaccine; conjugate