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Vaccination Programs: Client Reminder and Recall Systems


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997-2007) combined with more recent evidence (10 studies, search period 2007-2012). The finding updates and replaces the 2008 CPSTF finding for Client Reminder and Recall Systems pdf icon [PDF - 499 KB].

This review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing appropriate vaccination.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 490 KB].

Twenty-nine studies were included in the systematic review.

  • Overall vaccination rates increased by a median of 11 percentage points.
    • Client reminder and recall interventions used alone: median increase of 6 percentage points (14 studies).
    • Interventions implemented with additional components: median increase of 12 percentage points (15 studies).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 490 KB].

Evidence indicates client reminder and recall systems can reach a large number of clients and increase vaccination rates with relatively few economic resources.

Twenty-four studies were included in the review (search period 1980 – 2012). All monetary values are presented in 2013 U.S. dollars.

  • Median intervention group size: 654 (23 studies).
  • Median cost per person per year: $2.13 (23 studies)
  • Median cost per additional person vaccinated: $15 (22 studies)


Based on the results of the review, CPSTF findings should be applicable to the following:

  • Children, adolescents, and adults
  • Various populations
  • Clinical and community settings at different levels of scale—from individual practice settings to entire communities
  • Programs that use a range of intervention characteristics (e.g., reminder or recall, content, theoretical basis, and method of delivery)
  • Programs used alone or with additional components
  • Assorted vaccinations

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • How effective are client reminders that use emerging communication technologies such as text messaging?
  • Are interventions implemented by individual providers or healthcare systems, or through immunization information systems (IIS) effective? If so, are they cost-effective?
  • How effective are interventions with adolescent populations?
  • How effective are client reminders in communities with disparities in vaccination rates?

Study Characteristics

  • Evaluated interventions were used alone (14 studies) or with additional interventions (15 studies).
  • Studies were conducted in the United States (18 studies), Canada (3 studies), Denmark (1 study), New Zealand (1 study), and the United Kingdom (1 study).
  • Studies evaluated programs to address influenza (8 studies), influenza/pneumococcal (1 study), pneumococcal (1 study), DTP/DTaP (1 study), MMR (2 studies), tetanus (2 studies), and various childhood series (9 studies).