Use of reminders to increase compliance with tetanus booster vaccination

• HIT Description: A computerized patient registry that recorded patient diagnoses, prescriptions, treatment, and billing information. It allowed identifying patients due for preventive procedures at any time and generating reminders. More info...
  
• Purpose of Study: Compare the effectiveness and cost-effectiveness of three computerized reminder systems on compliance with tetanus vaccination.
  
• Years of study: Apr 1, 1985-March 31, 1986
  
• Study Design: Randomized controlled trial
  
• Outcomes: The proportion of patients who received tetanus toxoid during the study year or who had a claim of vaccination in the previous 10 years; staff and material costs of reminding the patient
  

• Settings: Family Medicine Center at the Ottawa Civic Hospital, Canada, a teaching unit of the university medical school. The Center has six practices, each with a staff physician, a nurse, and between three and five family-medicine residents. Four practiced participated in the trial.
• Intervention: 5589 patients 20 years of age or more were assigned to either a normal-care control group or one of three intervention groups Ð 1) physician reminders (passive, happened to patients who visit the practice), 2) telephone reminders (active, reach out to patients), or 3) letter reminders (active, reach out to patients). The reminders were generated by the computer.
• Evaluation Method: Reviewing computer records for compliance rate and comparing the cost-effectiveness of the three intervention arms with control group as the comparator.
• HIT System: Described elsewhere (Rosser WW, Fluker G. Software for family practice: a decade of development. Can Fam Physician 1984; 30:2567).
• Implementation: The computerized patient registry had been recording patient diagnoses, prescriptions, treatment, and billing information since 1976.
• Costs: Cost of HIT systems was not reported. Instead, cost reported was the operational cost for each intervention arm. The cost for the letter reminders was $6.05 for each additional vaccination recorded (not stated as to year, presumably 1988 Canadian dollars). In the telephone nurse reminder group, the cost of an additional vaccination was $5.43 at a salary of $15 per hour and $4.43 at $10 per hour. The physician required an estimated 15 seconds to discuss and record a patient's tetanus vaccination status. The cost per additional vaccination for the physician reminder was 43 cents at a physician salary of $60 per hour or 22 cents at $30 per hour.
• Clinical Outcomes: Changes in healthcare utilization: In the randomized control group, 3.2% of all those due for a tetanus vaccination obtained one during the study year. The physician's reminder added 19.6% (to 22.8%), the telephone reminder 20.8% (to 24.0%), and the letter reminder 27.4% (to 30.6%). The three intervention groups differed significantly from the randomized control group (p .00001).
• Changes in efficiency and productivity: The author claimed that computerized record systems offer a practical and efficient way to identify patients due for preventive procedures and to generate reminders to promote the procedures in a family practice. However, no comparison was made as to compare manual versus computer reminder generation approach.�