Understanding the Financial Implications of Immunization Reminder/Recall in a Multipractice Pediatric Group

A pilot randomized controlled trial of text messages to improve well-child visit attendance after no-show

OBJECTIVE

Evaluate the effectiveness of text messages to systematically engage parents/guardians ("caregivers") to reschedule a well-child visit (WCV) that was missed ("no-show") and attend that rescheduled WCV visits.

METHODS

Patients <18 years in one of five pediatrics or family medicine clinics, in one health system in the Southeast U.S., were eligible. Patients without a rescheduled WCV after a no-show were randomized into intervention (text messages) or care-as-usual comparison, stratified by language (English/Spanish). Enrollment occurred May-July 2022. Up to three text messages were sent to caregivers one week apart via REDCap and Twilio, advising how to reschedule the missed appointment by phone or health portal. Primary outcomes were (1) rescheduling a WCV within 6 weeks of no-show and (2) completing a rescheduled WCV within 6 weeks. Risk differences (RD) and odds ratios (OR) were used to evaluate the effect of text messages.

RESULTS

720 patients were randomized and analyzed (texts: 361, comparison: 359). The proportion rescheduling WCV after text versus usual care was English: 18.85% vs. 15.02%, respectively, and Spanish: 5.94% vs. 8.14%, with overall RD +1.98% (95% CI: -1.85, 5.81) and OR 1.21 (95% CI: 0.79, 1.84; p-value 0.38). Completed WCV rates in text or usual care were English: 13.08% vs. 6.59%, and Spanish: 5.81% vs. 5.94% with texts associated with RD +2.83% (95% CI: 1.66, 4.00) and OR 1.86 (95% CI: 1.09, 3.19).

CONCLUSION

Text message follow-up after a no-show WCV may positively impact attendance at WCVs rescheduled in the subsequent 6 weeks.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05086237.

Understanding Diversity of Policies, Functionalities, and Operationalization of Immunization Information Systems and Their Impact: A Targeted Review of the Literature

The COVID-19 pandemic has focused attention on the use of immunization information systems (IIS) to record and consolidate immunization records from a variety of sources to generate comprehensive patient immunization histories. Operationalization of IIS in the United States is decentralized, and as such, there are over 60 different IIS with wide variations in enabling policies and functionalities. As such, the policies that inform the development and operation of those sub-national IIS exist at the state and sometimes city levels. A targeted literature review was conducted to identify IIS policies and functionalities and assess their impact. The authors identified articles published from 2012 to 2022 that discussed or evaluated IIS policies and functionalities and screened titles, abstracts, and full text for inclusion. When selected for inclusion, authors extracted IIS policy/functionality characteristics and qualitative or quantitative outcomes of their implementation, where applicable. The search terms yielded 86 articles, of which 39 were included in the analysis. The articles were heterogeneous with respect to study design, interventions, outcomes, and effect measures. Out of the 17 IIS policies and functional components identified in the targeted literature review, the most commonly evaluated were provider-based patient reminder/recall, IIS-based centralized reminder/recall, and clinical decision support. Patient reminder/recall had the most published research and was associated with increased vaccination rates and vaccine knowledge. Despite the lack of quantitative evidence, there is a consensus that immunization data interoperability is critical to supporting IIS data quality, access, and exchange. Significant evidence gaps remain about the effectiveness of IIS functionalities and policies. Future research should evaluate the impact of policies and functionalities to guide improved utilization of IIS, increase national interoperability and standardization, and ultimately improve vaccination coverage and population health.

Costs of Interventions to Increase Vaccination Coverage Among Children in the United States: A Systematic Review

BACKGROUND

The Community Preventive Services Task Force (CPSTF) has recommended several interventions that have been demonstrated to be effective at increasing vaccination coverage.

OBJECTIVE

Conduct a systematic review to examine the costs of interventions designed to increase vaccination coverage among children and adolescents in the United States.

DATA SOURCES

PubMed, EconLit, Embase, and Cochrane.

STUDY ELIGIBILITY, PARTICIPANTS, AND INTERVENTIONS

Peer-reviewed articles from January 1, 2009 to August 31, 2019.

APPRAISAL AND SYNTHESIS METHODS

Studies were identified with systematic searches of the literature, reviewed for inclusion criteria, abstracted for data on intervention, target population, costs, and risk of bias. Cost measures were reported as costs per child in the target population, costs per vaccinated child, incremental costs per vaccinated child, and costs per vaccine dose administered. Results were stratified by intervention type, vaccine, and age group.

RESULTS

Thirty-seven studies were identified for full-text review. Across all interventions and age groups, the cost per child ranged from $0.10 to $537.38, and the incremental cost per vaccinated child ranged from $6.52 to $5,098.57. Provider assessment and feedback interventions had the lowest (median) cost per child ($0.17) and a healthcare system-based combined intervention with multiple components had the lowest (median) incremental cost per vaccinated child ($26.65). A community-based combined intervention with multiple components had the highest median cost per child ($537.38) and the highest median incremental cost per vaccinated child ($5,098.57).

LIMITATIONS

A small number of included intervention types and inconsistent cost definition.

CONCLUSIONS

There is substantial variability in the costs of CPSTF-recommended interventions.

The preferred method for reminding a child's vaccination schedule among Iranian parents

BACKGROUND

The most important reason for vaccination delay is the unawareness of the parents of vaccination schedule. The use of reminders can result in better vaccination coverage.

OBJECTIVES

This study aimed to determine the preferred method of receiving vaccination reminders from the parents' perspective.

STUDY DESIGN

Cross-sectional study.

METHODS

We studied the parents of under 7-year-old children who visited one of the six urban health centres in Mashhad for vaccination of their children in 2017. Three hundred parents were participated based on the convenience sampling method. Data were collected using a questionnaire consisting of five sections. Five Medical Informatics specialists confirmed the validity of the questionnaire. The data were analysed by descriptive-inferential statistics and the significance level was set at p < 0.05.

RESULTS

Around 94% of the participants wanted to be reminded about their children's vaccination schedule. Most of them (74.3%) preferred to receive reminders by short text messaging (SMS) and 42% preferred to be reminded 1 day before the vaccination date (n = 42%). The tendency to receive reminders and the preferred method had no significant correlation with participants' age, education degree and residential area.

CONCLUSIONS

The preferred reminder method from the parents' perspective was SMS. Despite the growth of information technology as well as people's access to the Internet, it seems that use of other methods such as SMS to remind and specifically educate parents in this respect is more common.