The Impact of Reminder-Recall Interventions on Low Vaccination Coverage in an Inner-City Population

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Abstract
Background Reminder-recall interventions have improved immunization rates in numerous studies. Objective To evaluate the impact of large-scale, registry-based reminder-recall interventions on low immunization rates in an inner-city population. Design Randomized, controlled, effectiveness trial. Setting Fulton County, Georgia. Participants A total of 3050 children (76% black, 14% Hispanic, 7% white, and 3% other or unknown; median age, 9 months; range, 1-14 months) identified in an immunization registry as receiving health care in the public sector. Interventions Each child was randomly assigned to 1 of 4 groups: control (usual care), autodialer (automated telephone or mail reminder recall), outreach (in-person telephone, mail, or home visit recall), and combination (autodialer with outreach backup). Interventions continued until the child reached 24 months of age. Main Outcome Measure Completion by the age of 24 months of the 4-3-1-3 vaccination series based on intention-to-treat analysis. Results A total of 260 (34%) of the 763 patients in the control group, 306 (40%) of the 763 in the autodialer group, 284 (37%) of the 760 in the outreach group, and 293 (38%) of 764 in the combination group completed the vaccination series. Conclusion Large-scale, registry-based reminder-recall interventions produced only small improvements in low immunization rates of an inner-city population.

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