National Immunization Conference 2005 March 22, 2005 ~ Washington D.C. Assessing Reminder and Recall Training in Public and Private Clinics in Los Angeles County National Immunization Conference 2005 March 22, 2005 ~ Washington D.C.

Presenters and Authors Pierre W. Nsilu, MPA. MPH Los Angeles County Immunization Program Authors: Susan Ashkar, MA Melissa Ely Moore, MPH

Reminder and Recall (R/R) What is reminder/recall? Tracking system used to remind patients that immunizations are due soon (Reminder) or past due (Recall) Reminder: Before the appointment, the patient receives a reminder postcard/letter or telephone message reminding him/her of upcoming appointment Recall: After missing the appointment, the patient receives a postcard/letter or telephone recalling him/her to the office

Importance of R/R R/R is an effective tool to increase immunization coverage recommended by: The National Vaccine Advisory Committee in 1995 The Guide to Community Preventive Services in 1999 Others Szilagyi et al., November 2002 Le Baron et al., March 2004 Both of the authors support the use of R/R. Szilagyi: Le Baron:

Reminder/Recall Training Training consists of: On-site training to integrate postcards into existing clinic flow Distribution of boxes with postage-paid postcards and training manual Ongoing technical assistance and follow-up offered post-training

R/R Survey In Spring 2004 LACIP staff conducted a survey to: Determine whether providers trained are still conducting R/R Determine if providers are using only Reminder, only Recall or using both Reminder and Recall Determine any barriers to conducting R/R Determine if using other methods of R/R (e.g., postcards, telephone or registry)

R/R Survey (cont.) Sample Selection 280 clinics received training between July 2001 and November 2003 135 clinics selected using PPS method Surveys conducted by telephone interview Participants received a $10 gift card upon completion of interview PPS is the Probability Proportionate Sample selection which is used to give a sample representative of all clinic population sizes as well as geographic location in Los Angeles County.

Survey Results General information about providers 84% of respondents have been conducting R/R for more than a year 76% of respondents spend two or more hours per week conducting R/R 67% of respondents report making 3 or more attempts to recall patients who don’t show Respondents estimate that 50% of patients return because of postcard reminders

Survey Results (cont.) 90% of respondents were still using R/R (n=121) Of those using R/R: 100% use reminder 96% use recall Those not using R/R (n=13) reported: Small pediatric population (23%) Insufficient number of staff (15%) No time (8%) Some reasons given were: small pediatric population Insufficient number of staff No time N=121 and 13 1 clinic did not respond.

Reminder Methods A clinic may use more than one method

Recall Methods Again a clinic may choose to use more than one method.

Barriers Barriers cited: Move or Gone elsewhere (9%) Incomplete locating information (8%) Not enough staff (3%) Record incomplete (2%) Language barriers (1%) 79% of providers stated they had no barriers to implementing R/R When providers were asked about barriers to implementing R/R in their practices They stated the following barriers

Recommendations LACIP is revising R/R protocol to include more options such as: Telephone/Autodialer Existing medical practice management software Referral for AFIX case management process Referral to Immunization Registry 110 sites deployed since November 2002 5000 sites to deploy in years to come Survey evaluate out R/R training, we are revising our protocol and will include more options such as Tel, Existing medical practice management software such as Medical Manager. We will refer clinics to our expanded AFIX known as Immunization Practices Improvement Initiative and through it we are working closely with providers, to help them improve their practices and immunization rates through a case management process. Statement about the registry Provide referral to the registry 110 sites deployed so far and continue to deploy until the will reach 5000

Conclusion LACIP R/R training is very successful Approximately 90% of sampled providers still employ reminder and/or recall To conclude our R/R training was very successful. Providers visited before did not know the difference between Reminder and Recall. Now I’m finding out during my follow up visit and our survey that providers are able to define what is Reminder/Recall.

Avenues for Further Evaluation Quality assurance audits IPII (AFIX) case management CASA evaluations Missed Opportunity Chart Assessments (MOChA) Since our survey evaluated only our training, we did not evaluate the use of R/R in improving IZ practices in providers offices. Other avenues we have to evaluate if R/R improve coverage rates are: By conducting Quality Assurance Reviews (go to MDs offices, observe their practices and make recommendations) Immunization Practices Improvement Initiative (already mentioned) CASA evaluation Mocha: to look more details (e.g., child had fever-shots not given) To see if it is a true missed opportunity.

Immunization Program 3530 Wilshire Blvd Suite 700 Los Angeles, CA 90010 Phone # 213-351-7800 Fax # 213-351-2780 www.lapublichealth.org/ip/