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J Adolesc Health. 2015 May;56(5 Suppl):S21-6. doi: 10.1016/j.jadohealth.2014.11.023.

Direct messaging to parents/guardians to improve adolescent immunizations.

Author information

1
Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio; Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio.
2
Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio.
3
Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio.
4
Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio; Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio; Department of Biostatistics and Epidemiology, Case Western Reserve University, Cleveland, Ohio; Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio. Electronic address: David.kaelber@case.edu.

Abstract

PURPOSE:

To study the impact on adolescent immunization rates of direct messages to parents/guardians.

METHODS:

Electronic health record rules identified adolescents needing an immunization. Parents/guardians of adolescents were messaged via a single vendor using automated text, prerecorded voice, and/or postcard.

RESULTS:

Parents/guardians of 3,393 patients, ages 11-18 years, with one or more primary care visits in the prior 2 years, identified as needing (average of 2.04 years) a vaccination (meningococcal conjugate, human papillomavirus, or tetanus, diphtheria, and pertussis vaccines) were messaged (mean age, 14 years; 50% male; 38% African-American; 23% white; 19% Hispanic; and 79% public health insurance). A total of 7,094 messages were sent: 3,334 automated voice (47%), 2,631 texts (37%), and 1,129 postcards (16%). After the first message, 865 adolescents (25.5%) received at least one vaccine. Within 24 weeks of messaging 1,324 vaccines (745 human papillomavirus; 403 meningococcal conjugate; and 176 tetanus, diphtheria, and pertussis vaccines) occurred in 959 visits (83.8% physician visits and 16.2% nurse visits). Average visits generated $204 gross reimbursement for $1.77 in messaging expenses per vaccine given. No differences in immunization completion rates occurred by age, gender, race/ethnicity, or insurance type. At 24 weeks, one message was more effective than two or three messages (35.6%, 19.4%, and 24.1% effectiveness, respectively; p < .0001). Texts and postcards correlated with more vaccination visits (38.8% and 40.1%, respectively) than phone calls (31.5%; p = .04). More vaccines due led to increasing message effectiveness.

CONCLUSIONS:

Automated texts, voice messages, and postcards had a significant positive effect on vaccination rates in adolescents needing vaccination and required minimal financial expenditure.

KEYWORDS:

Adolescent immunizations; Automated postcards; Automated telephone calls; Automated texting; Electronic health record; Immunization reminders

[Indexed for MEDLINE]

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