Childhood Immunizations: A Pilot Study Evaluating the Effectiveness of Reminder/Recall Systems and Perceptions of Patient Tracking Systems

Publication Date


Type of Culminating Activity


Degree Title

Master of Health Science, Health Promotion

Major Advisor

Sarah E. Toevs


James T. Girvan


Rudy Andersen


Despite national and state immunization initiatives and laws, Idaho’s childhood immunization coverage levels continue to fall below Healthy People 2010 goals of ≥ 90% coverage (Healthy People 2010, 2001). Significant disparities in immunization coverage rates exist between 2-year olds and school age children. This disparity is due, in part, to a complex immunization schedule requiring between 15-19 doses of vaccine by 18 months of age, and despite school laws requiring children to be immunized by the time they being school (Gore et al., 1999; MMWR, 1999). As a result, children are falling behind in immunizations and they must play catch up upon entering preschool or kindergarten.

Reminder/recall and patient tracking systems are recommended as methods to increase childhood immunization rates. The literature review revealed, however, conflicting results as to the effectiveness of reminder/recall systems to increase immunization rates and indicates further investigation and additional interventions are needed (Alto, Fury, Condo, Doran, & Aduddell, 1994; Atkinson, Wolfe, Humiston, & Nelson, 2000; LeBaron, Starnes, Dini, Chambliss, & Chaney, 1998; Szilagyi et al., 2000).

The focus of this study was two-fold. The first component implemented and evaluated the effectiveness of a reminder/recall pilot study in Southern and Eastern Idaho; the second component provided a qualitative analysis of clinic immunization administrator perceptions toward patient tracking systems.

Results of the reminder/recall pilot study showed no difference in immunization rates between the control group and the treatment groups of postcard, phone call, phone call, or postcard, postcard, phone call. Findings from the qualitative analysis indicate that clinics have goals or mission statements targeting childhood immunizations and are making efforts to increase their rates. Additional findings indicate that personnel responsible for tracking childhood immunizations spend between 3-8 hours each week performing data entry. Clinic administrators stated they believed a statewide immunization registry was necessary in Idaho and that patient tracking and documentation were fundamental problems with immunizing children, that subsequently result in low coverage levels.

Suggestions for further research include tracking subject’s immunization status individually through the use of a registry rather than tracking whether patients return to a particular clinic for a vaccination.

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