A randomized trial of the effect of centralized reminder/recall on immunizations and preventive care visits for adolescents.

OBJECTIVE: To assess the impact of a managed care-based patient reminder/recall system on immunization rates and preventive care visits among low-income adolescents. METHODS: We conducted a randomized controlled trial between December 2009 and December 2010 that assigned adolescents aged 11-17 years to one of three groups: mailed letter- telephone reminders- or control. Publicly insured youths (n = 4115) were identified in 37 participating primary care practices. The main outcome measures were immunization rates for routine vaccines (meningococcus- pertussis- HPV) and preventive visit rates at study end. RESULTS: Intervention and control groups were similar at baseline for demographics- immunization rates- and preventive visits. Among adolescents who were behind at the start- immunization rates at study end increased by 21% for mailed (P < .01 vs control)- 17% for telephone (P < .05)- and 13% for control groups. The proportion of adolescents with a preventive visit (within 12 months) was: mailed (65%/ P < .01)- telephone (63%/ P < .05)- and controls (59%). The number needed to treat for an additional fully vaccinated adolescent was 14 for mailed and 25 for telephone reminders/ for an additional preventive visit- it was 17 and 29. The intervention cost \$18.78 (mailed) or \$16.68 (phone) per adolescent per year to deliver. The cost per additional adolescent fully vaccinated was \$463.99 for mailed and \$714.98 for telephone/ the cost per additional adolescent receiving a preventive visit was \$324.75 and \$487.03. CONCLUSIONS: Managed care-based mail or telephone reminder/recall improved adolescent immunizations and preventive visits- with modest costs and modest impact.