Getting under the hood: exploring issues that affect provider-based recall using an immunization information system

Objective: To assess 1) pediatric practices' use of provider-based recall using an immunization information system 8 months after training on the recall process; 2) initiation and sustainability barriers to provider-based recall using an immunization information system; 3) strategies that facilitated recall initiation; and 4) recommendations for alternative approaches for conducting recall.

Methods: In 2008, 11 practices received training on the automatic recall function in the Colorado Immunization Information System (CIIS) for both infants and adolescents. The 2-hour computer-based training provided an opportunity for attendees to run real-time recall reports with CIIS staff assistance. Eight months later, key informant interviews were conducted with 24 providers and staff from these practices.

Results: Eight months after training, only 4 of 11 practices had implemented recall using CIIS: 3 practices recalled children ≤2 years of age, and 1 practice recalled adolescent girls for human papillomavirus vaccine. Initiation barriers included lack of awareness of baseline immunization rates, distrust in the accuracy of CIIS-generated data, and perceived difficulties recalling adolescents. Having unrealistic expectations about recall effectiveness was a barrier to sustainability. Strategies that facilitated recall included having a dedicated staff person for recall efforts and recalling children ≤2 years of age. Most key informants viewed population-based recall conducted by public health departments or schools as an acceptable alternative to provider-based recall.

Conclusions: Even with a promising tool to assist pediatric offices, implementing provider-based recall is challenging for pediatric practices. Given existing barriers, providers expressed support for alternative recall methods.