Vaccine reminders work: Cochrane review

Sending reminders when consumers are due for their next vaccination could boost uptake by up to 8%, a new review suggests

An updated Cochrane Review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve immunisation rates.

While rates of vaccination against infectious diseases in children and adults are improving overall internationally, under-vaccination remains a problem, the researchers highlight: for example, in Europe, 11,316 cases of measles were reported during 2012, and an estimated four to 50 million symptomatic cases of flu occur each year.

The systematic review summarises the results of 75 studies from 10 countries, including 55 studies involving 138, 625 children, adolescents and adults.

There were 29 studies of reminders for routine immunisations in infants and children such as MMR and polio, 24 studies of influenza vaccination in adults, 12 studies of adolescent immunisations, eight studies of routine immunizations in adults such as tetanus or hepatitis B, and five studies of influenza vaccination in children.

Fifty-eight studies were performed in the US, while the remainder were conducted in Australasia, Europe and Africa.

The studies looked at reminders, sent when a vaccination is due because of age or risk factors; and recall, sent when vaccinations are overdue, via letter, postcard, phone call, computerised phone call or text message.

These methods were compared to no reminders, media-based activities aimed at promoting vaccination, or simple GP-based immunisation awareness campaigns.

The Cochrane researchers found that reminder and recall systems increased the number of children and adults receiving any kind of immunisation.

Reminding people that they have an upcoming vaccination probably increases the number of who receive vaccinations, the authors say: based on the results from combining studies in adults and children, about 8% more people received a vaccination following a reminder compared with no reminder.

Similar results were found in children and adults when they were analysed separately. The researchers noted variation in the results of the studies and the difference in the effect of reminders could vary when used in different settings.

There is high quality evidence that postcards, text messages and computerized telephone calls are all effective methods for delivering reminders, they say.

“The evidence shows that reminding people to have vaccinations increases the number of people who receive vaccinations,” says lead Cochrane author, Julie Jacobson Vann from the University of North Carolina at Chapel Hill School of Nursing.

“All types of patient reminder and recall are likely to be effective, and reminding people over the telephone was most effective. Even a small effect of patient reminders and recalls, when scaled to a whole population, could have a large beneficial effect on public health.

“We have the technology to incorporate patient reminders and recall into routine primary care. Reminder and recall systems need to be tailored to each health service setting to maximise their effectiveness, for example person-to-person telephone reminders are effective, but they may also be more costly than other methods.”

“As technologies develop we need to consider how they can enhance reminder and recall interventions.

“For example, we need to learn more about the characteristics of the most effective centralised and text message interventions.”

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