Children’s Outcomes Research Program, Children’s Hospital Colorado, Aurora, Colorado 80045, USA.
Pediatrics. 2012 Jun;129(6):e1437-45. doi: 10.1542/peds.2011-1714. Epub 2012 May 7.
To assess the effectiveness of reminder/recall (R/R) for immunizing adolescents in private pediatric practices and to describe the associated costs and revenues.
We conducted a randomized controlled trial in 4 private pediatric practices in metropolitan Denver. In each practice, 400 adolescents aged 11 to 18 years who had not received 1 or more targeted vaccinations (tetanus-diphtheria-acellular pertussis, meningococcal conjugate, or first dose of human papillomavirus vaccine for female patients) were randomly selected and randomized to intervention (2 letters and 2 telephone calls) or control (usual care) groups. Primary outcomes were receipt of >1 targeted vaccines and receipt of all targeted vaccines 6 months postintervention. We calculated net additional revenue for each additional adolescent who received at least 1 targeted vaccine and for those who received all targeted vaccines.
Eight hundred adolescents were randomized to the intervention and 800 to the control group. Baseline rates of having already received tetanus-diphtheria-acellular pertussis, meningococcal conjugate, and first dose of human papillomavirus vaccine before R/R ranged from 33% to 54%. Postintervention, the intervention group had significantly higher proportions of receipt of at least 1 targeted vaccine (47.1% vs 34.6%, P < .0001) and receipt of all targeted vaccines (36.2% vs 25.2%, P < .0001) compared with the control group. Three practices had positive net revenues from R/R; 1 showed net losses.
R/R was successful at increasing immunization rates in adolescents and effect sizes were comparable to those in younger children. Practices conducting R/R may benefit financially if they can generate additional well-child care visits and keep supply costs low.
评估在私人儿科诊所中使用提醒/召回（R/R）对青少年进行免疫接种的效果，并描述相关的成本和收益。
我们在丹佛大都市的 4 家私人儿科诊所进行了一项随机对照试验。在每个诊所中，随机选择并随机分配 400 名年龄在 11 至 18 岁之间、未接受过 1 种或多种目标疫苗接种（破伤风、白喉、无细胞百日咳、脑膜炎球菌结合疫苗或女性患者的人乳头瘤病毒疫苗首剂）的青少年进入干预（2 封信和 2 个电话）或对照组（常规护理）。主要结局是接受>1 种目标疫苗和接受所有目标疫苗接种后 6 个月。我们计算了每增加一个接受至少 1 种目标疫苗接种的青少年和所有目标疫苗接种的青少年的净额外收益。
800 名青少年被随机分配到干预组，800 名被分配到对照组。在 R/R 之前，已经接受破伤风、白喉、无细胞百日咳、脑膜炎球菌结合疫苗和人乳头瘤病毒疫苗首剂的青少年的基线率为 33%至 54%。干预后，干预组接受至少 1 种目标疫苗接种的比例明显高于对照组（47.1%比 34.6%，P<0.0001），接受所有目标疫苗接种的比例也明显高于对照组（36.2%比 25.2%，P<0.0001）。有 3 个实践从 R/R 中获得了正的净收益，1 个实践则出现了净亏损。
R/R 成功地提高了青少年的免疫接种率，其效果大小与对幼儿的效果相当。如果能够增加常规儿童保健就诊次数并保持供应成本低廉，实施 R/R 的实践可能会在财务上受益。
