Rosser WW et al. 1992 "Use of reminders to increase compliance with tetanus booster vaccination."

Reference
Rosser WW, Hutchison BG, McDowell I, et al. Use of reminders to increase compliance with tetanus booster vaccination. Can Med Assoc J 1992;146(6):911-917.
Abstract
"Objective: To assess the effect of three computerized reminder systems on compliance with tetanus vaccination. Design: Prospective randomized controlled trial. Setting: Ottawa Civic Hospital Family Medicine Centre. Participants: Of 8069 patients 20 years of age or more who were not in a hospital or institution 5589 were randomly assigned, by family, to a control group, a physician reminder group, a telephone reminder group or a letter reminder group. The remaining 2480 patients were not included in the randomized portion of the study but were monitored. Results are presented for the 5242 randomized patients and the 2369 nonrandomized patients for whom there was no up-to-date record of tetanus vaccination at the start of the trial. Interventions: For the patients in the physician reminder group the physician was reminded at an office visit to assess the patient's tetanus vaccination status and to recommend vaccination; those in the other two reminder groups received a telephone call or letter enquiring about their tetanus vaccination status and recommending a booster dose. Main outcome measure: Proportion of patients who received tetanus toxoid during the study year or who had a claim of vaccination in the previous 10 years. Main results: The rate of recorded tetanus vaccination in the randomized control group was 3.2%. The difference between that rate and those for the three reminder groups was 19.6% in the physician reminder group (95% confidence interval [CI] 17.1% to 22.2%, p < 0.00001), 20.8% in the telephone reminder group (95% CI 18.3% to 23.5%, p < 0.00001) and 27.4% in the letter reminder group (95% CI 24.8% to 30.2%, p < 0.00001)). The letter reminders were more effective than either the telephone reminders (p = 0.00013) or the physician reminders (p < 0.00001) in improving compliance. The cost to the practice per additional vaccination recorded was $0.43 for the physician reminders, $5.43 for the telephone reminders and $6.05 for the letter reminders. Conclusions: Although all three reminder systems increased the rate of recorded tetanus vaccination they fell far short of achieving complete population coverage. More intensive interventions would be required to approach that goal. However, such interventions do not appear to be justified given the rarity of tetanus."
Objective
"To assess the effect of three computerized reminder systems on compliance with tetanus vaccination."
Type Clinic
Primary care
Type Specific
Family practice
Size
Large
Geography
Urban
Other Information
The study site was "the Ottawa Civic Hospital Family Medicine Centre[, which] consists of six teaching medical practices. Each practice was comprised of a staff physician, a nurse and three or four residents. Since 1976 all of the 10,000 or so patients attending the centre have been registered on a computer database."
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Type of Health IT Functions
Physician reminder group: "For patients in the physician reminder group a computer-generated reminder to ask the patient about tetanus vaccination was included on the routinely printed encounter form used for billing purposes. Until information about the procedure was recorded the computer continued to generate reminders at subsequent visits." Telephone reminder group: "In the telephone and letter groups...at the beginning of each 2-week study period the computer printed a list of names and telephone numbers of patients to be contacted. For the telephone reminders the practice nurse attempted to contact the family, making a maximum of five calls during office hours." Letter reminder group: "In the telephone and letter groups...at the beginning of each 2-week study period computer printed a list of names and telephone numbers of patients to be contacted...Patients in the letter reminder group were sent a computer-generated letter, signed by their physician and nurse, enquiring about their tetanus vaccination status and recommending a booster every 10 years. A prepaid envelope was included for their reply. A second reminder was sent to nonrespondents after 21 days."
Workflow-Related Findings
"Physicians required an estimated 15 seconds to discuss and record a patient's tetanus vaccination status."
Approximately 19.6 percent of patients whose physicians received reminders were vaccinated, compared to 2.3 percent and 3.2 percent in the two control groups.
Study Design
Randomized controlled trial (RCT)
Study Participants
The authors "included 8069 patients 20 years of age or more who were not in a hospital or an institution. Two of the six practices (representing 2480 patients) did not participate in the study. The physicians in these practices did not change their usual approach to tetanus vaccination. These patients were used as a reference point to assess the extent of contamination in the control group. Contamination occurred if the study physicians recommended tetanus vaccination to control patients more often than they would have outside of the study."