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Reminders for immunisation increase immunisation rates

A question asked of Bandolier was whether all the effort put into trying to make sure that children and adults had the proper vaccinations was worthwhile. Does it have any effect on immunisation rates? The answer from a Cochrane review [1] is that it does.


A typically thorough search strategy looked for papers with the following criteria:

Eligible study designs were randomised controlled trials, controlled before and after studies, or interrupted time series. Reminders were interventions that reminded patients about immunisations that were due, and recalls reminded patients about those that were overdue.


There were 41 studies in the review. Reminders or recalls were found to be effective in 33 of them (80%). Reasons for failure to achieve benefit in the other eight were varied. They were mostly to do with design (small sample size), setting (already had very high or low immunisation rates) or because they were primarily directed at other interventions or outcomes.

The analysis examined vaccination of children and adults separately, but the main thrust of the results was much the same. Telephone reminders were the most effective (Figure), but most types of interventions were effective. Telephone reminders produced an average absolute increase of immunisation rates of 25% or more in adults and children. Other reminders produced smaller absolute increases, often of about 10%. The improvement in immunisation rates was not associated with baseline immunisation levels, which ranged from 1% to 86% in control groups at the start of the studies.

Figure: Effects of different reminder/recall methods on odds ratios for immunisation rates in adults and children


Reading this review reminds us how persuasive and pervasive the Cochrane Collaboration is becoming. This review will also appear on the Cochrane Library, with full details of all the studies and their results. It will therefore be a useful resource for those who want to examine how immunisation reminders are performed and managed on their patch. It might stimulate research in how to make immunisation uptake higher. It should certainly comfort those who wonder whether all the effort they put in to increase immunisation rates is having an effect. The research evidence is that it does.

For people who want to know the details of each of the individual trials, perhaps to see which applies most closely to their own situation, these will soon be available on an electronic format of the review in the Cochrane Library. The sorts of detail that will hardly ever be available in paper formats should be available with a few clicks. Your library should have it, or an organisation like or NeLH will give you free access.


  1. PG Szilagyi et al. Effect of patient reminders/recall interventions on immunization rates. JAMA 2000 284: 1820-1827.
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