1. 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.

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

3. 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

4. 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:

5. 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

6. 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)

7. 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.

8. 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

9. 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 clinic did not respond.

10. Reminder Methods
A clinic may use more than one method

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

12. 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

13. 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

14. 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.

15. 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.

16. Immunization Program
3530 Wilshire Blvd Suite 700
Los Angeles, CA 90010
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