Szilagyi P G, Bordley C, Vann J C, Chelminski A, Kraus R M, Margolis P A, Rodewald L E
University of Rochester School of Medicine and Dentistry, Box 632, Strong Memorial Hospital, 601 Elmwood Ave, Rochester, NY 14642, USA. peter_szilagyi@urmc. rochester.edu
JAMA. 2000 Oct 11;284(14):1820-7. doi: 10.1001/jama.284.14.1820.
Immunization rates for children and adults remain below national goals. While experts recommend that health care professionals remind patients of needed immunizations, few practitioners actually use reminders. Little is known about the effectiveness of reminders in different settings or patient populations.
To assess the effectiveness of patient reminder systems in improving immunization rates, and to compare the effectiveness of different types of reminders for a variety of patient populations.
A search was performed using MEDLINE, EMBASE, PsychINFO, Sociological Abstracts, and CAB Health Abstracts. Relevant articles, as well as published abstracts, conference proceedings, and files of study collaborators, were searched for relevant references.
English-language studies involving patient reminder/recall interventions (using criteria established by the Cochrane Collaboration) were eligible for review if they involved randomized controlled trials, controlled before-after studies, or interrupted time series, and measured immunization rates. Of 109 studies identified, 41 met eligibility criteria. Studies were reviewed independently by 2 reviewers using a standardized checklist. Results of studies are expressed as absolute percentage-point changes in immunization rates and as odds ratios (ORs). Studies with similar characteristics of patients or interventions were pooled (random effects model).
Patient reminder systems were effective in improving immunization rates in 33 (80%) of the 41 studies, irrespective of baseline immunization rates, patient age, setting, or vaccination type. Increases in immunization rates due to reminders ranged from 5 to 20 percentage points. Reminders were effective for childhood vaccinations (OR, 2.02; 95% confidence interval [CI], 1.49-2.72), childhood influenza vaccinations (OR, 4. 25; 95% CI, 2.10-8.60), adult pneumococcus or tetanus vaccinations (OR, 5.14; 95% CI, 1.21-21.78), and adult influenza vaccinations (OR, 2.29; 95% CI, 1.69-3.10). While reminders were most effective in academic settings (OR, 3.33; 95% CI, 1.98-5.58), they were also highly effective in private practice settings (OR, 1.79; 95% CI, 1. 45-2.22) and public health clinics (OR, 2.09; 95% CI, 1.42-3.07). All types of reminders were effective (postcards, letters, and telephone or autodialer calls), with telephone reminders being most effective but costliest.
Patient reminder systems in primary care settings are effective in improving immunization rates. Primary care physicians should use patient reminders to improve immunization delivery. JAMA. 2000;284:1820-1827.
儿童和成人的免疫接种率仍低于国家目标。虽然专家建议医护人员提醒患者进行必要的免疫接种，但实际很少有从业者使用提醒措施。对于不同环境或患者群体中提醒措施的有效性，人们了解甚少。
评估患者提醒系统在提高免疫接种率方面的有效性，并比较不同类型提醒措施对各种患者群体的有效性。
使用MEDLINE、EMBASE、PsychINFO、Sociological Abstracts和CAB Health Abstracts进行检索。搜索了相关文章以及已发表的摘要、会议论文集和研究合作者的文件以获取相关参考文献。
涉及患者提醒/召回干预措施（使用Cochrane协作组织制定的标准）的英文研究，如果涉及随机对照试验、前后对照研究或中断时间序列，并测量免疫接种率，则有资格进行综述。在确定的109项研究中，41项符合纳入标准。由2名评审员使用标准化清单独立评审研究。研究结果以免疫接种率的绝对百分点变化和比值比（OR）表示。具有相似患者或干预特征的研究进行合并（随机效应模型）。
在41项研究中的33项（80%）中，患者提醒系统在提高免疫接种率方面是有效的，无论基线免疫接种率、患者年龄、环境或疫苗接种类型如何。提醒措施导致的免疫接种率提高幅度为5至20个百分点。提醒措施对儿童疫苗接种有效（OR，2.02；95%置信区间[CI]，1.49 - 2.72），儿童流感疫苗接种有效（OR，4.25；95% CI，2.10 - 8.60），成人肺炎球菌或破伤风疫苗接种有效（OR，5.14；95% CI，1.21 - 21.78），成人流感疫苗接种有效（OR，2.29；95% CI，1.69 - 3.10）。虽然提醒措施在学术环境中最有效（OR，3.33；95% CI，1.98 - 5.58），但在私人执业环境（OR，1.79；95% CI，1.45 - 2.22）和公共卫生诊所（OR，2.09；95% CI，1.42 - 3.07）中也非常有效。所有类型的提醒措施都有效（明信片、信件以及电话或自动拨号呼叫），其中电话提醒最有效但成本最高。
初级保健环境中的患者提醒系统在提高免疫接种率方面是有效的。初级保健医生应使用患者提醒来改善免疫接种服务。《美国医学会杂志》。2000年；284：1820 - 1827。
