Having worked with providers over the last several years to develop quality improvement strategies to improve vaccination rates, one thing has become clear… immunization reminder/recall systems work,
and you can’t use one without the other. Reminder and recall, although two separate activities, must exist together to raise immunization rates and remind patients and parents how important their or their child’s health is to you as the provider. Reminder/recall is an important component of any immunization provider’s practice to ensure people get the vaccines they need. Reminder systems track upcoming and future appointments and recall systems track missed appointments. Combining both is a powerful method for ensuring optimal vaccination rates, and improving overall health care.
Most providers/clinics today have Electronic Health/Medical Records systems in place and use electronic scheduling systems. However, not every scheduling system is set up to assist providers to adequately perform reminder/recall directly from the system. Clinics that cannot generate reminder/recall processes from their system should have a “plan” in place. The plan can include calling, texting or emailing the patient/parent to remind them that their next visit is coming due or to remind them that they missed an appointment. This is an opportunity to engage the patient or parent to schedule or reschedule the appointment. Specifically assigning one or more of your employees to this task will ensure that your patient outreach efforts are successful and patients are appropriately scheduled.
The type of system used for patient recall/reminders can vary, but all clinic staff must use the system regularly. Consider the following ideas taken from the AAP Immunization Resources “Immunization Reminder & Recall Systems,” updated 5/2014:
- An “immunization information gap” frequently exists in provider practices. Parents/patients often do not know the vaccination status of their children or themselves and health care providers sometimes perceive coverage among their patients as higher than it really is.
- Providers should ask themselves, “How well am I doing at vaccinating my patients?” To understand your practice’s vaccination rates, contact the state health department to request an official assessment of coverage and follow-up.
- Office organization is essential. Offices utilize varied record-keeping systems, such as postcards, telephone calls, or a variety of techniques.
- The key is to create a system that works efficiently for your clinic and allows personnel to identify patients in need of vaccinations.
- One size does not fit all. Successful recall systems vary from tickler files to immunization registries. These systems are dependent upon your staff’s ability to utilize the system and fine-tune it to meet the specific needs of the practice.
There are several methods that work. The “trick” is finding what will work for your practice’s environment.
- Chart reminders in pop-up boxes or “Best Practice Advisory:”
- Advantages: Inexpensive and efficient, can easily become part of the routine
- Disadvantages: Can only be used with those patients who already have a visit scheduled
- Mail/Telephone reminders where staff phone or send a postcard or letter reminding a patient that a visit either needs to be scheduled, or an appointment was missed and another appointment needs to be scheduled:
- Phone contact can help to ensure that the message is understood and provides the opportunity to schedule an appointment
- Reaches patients who otherwise may not have scheduled appointments
- Easy to implement, requiring minimal staff time
- Can help a clinic determine if a patient has moved or gone elsewhere (MOGE) for service
- Relies on the patient to schedule and keep appointments
- Not useful in practices with high patient turnover or with a population that changes residences frequently
- May need bilingual reminders
Not mentioned in the reminder/recall article was the importance of scheduling the next vaccine visit before the patient/parent leaves the office. By scheduling the visit prior to the patient leaving, clinic staff has the ability to track next appointments, make reminder phone calls, and follow-up on missed appointments in a more timely manner. Making sure that all staff are aware when follow-up immunizations are due is a key component in scheduling next visits and performing reminder/recall. However, scheduling the next visit may be difficult if the system is not designed to schedule beyond a specific time frame.
Developing or refining your reminder/recall system in your clinic is now becoming more important than ever. Many of the COVID-19 vaccines that are currently in development will be administered in two doses separated by 21 or 28 days, depending on the vaccine presentation. Having a robust reminder/recall system will aid in tracking patients to remind them when their second dose is due.
If you have questions or need additional information, please contact CDPHE’s immunization branch at 303-692-2700 or firstname.lastname@example.org. For more information on this topic, there are several resources: