The studies cited below reinforce the conclusion that consistent communication between providers and patients is a major key to improving national health rates.

The CDC Pilot Studies of Automated Calling Technology

Studies conducted in Georgia and Colorado by the Centers for Disease Control and Prevention focused on the use of automated reminder/recall systems to establish reliable methods of significantly raising immunization rates for children nationwide.
The results were dramatic:
 
Composite kept appointment rates for children whose parents received the automated reminder were 59% compared to 33% for children of parents who did not receive reminders, a jump of 81%.

Importantly, studies have verified an overwhelmingly positive response to this technology. From a report on the survey that followed a study of the impact of computer-generated phone calls on immunization rates in Denver, Colorado:

"The 10% random sample of parents who received telephone calls revealed an almost unanimous approval of the calls. Of those expressing an opinion, 199 of 200 (99.5%) expressed a positive opinion about the phone calls. In addition, parents continue to express statements of appreciation about receiving automated telephone notifications, even after four or more scheduled immunization events."      

Immunization had the highest improvement, with a 183% increase in kept-appointment rates.

From an unpublished manuscript by Eugene F. Dini, MPA, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 

Objective:  To evaluate the effectiveness of computer-generated telephone reminder calls in increasing kept appointment rates in a public health setting. 

Design: Randomized controlled trial. 

"The importance of reminder/recall systems designed to keep children in the health care provision system was recently stressed by the National Vaccine Advisory Committee. While systems using letters, postcards, personal phone calls, and home visits have been associated with improved clinic attendance,  the high costs for materials and labor associated with these reminder/recall systems have often prevented their widespread use by state and local health departments and private practitioners. Several recent evaluations have suggested that computer-generated telephone messages may provide an inexpensive, labor-saving method of improving adult and childhood immunization clinic attendance."    


Conclusion: These results suggest a simple and effective method to increase kept appointment rates in a variety of public health programs.

Intervention:  Households of children were randomized to receive or not receive a general or vaccine specific computer generated telephone reminder or recall message the day before the child was due, or immediately after randomization if the child was late.

Results:  Of the 4636 children whose households were randomized to receive a message, 1684 (36.3%) visited the health department within 30 days compared with 955 (28.4%) of the 3366 children whose households were not contacted. Immunization visits were more frequent (41.1%) among the 3257 children whose households actually received the message. Improvement in immunization visits was similar for general and specific messages, and the greatest for children who were late for the third dose...
(From Arch Pediatr Adolesc Med, volune 148,Sept 1994, by Robert W. Linkins, PhD, Eugene F. Dini, MPA; Grace Watson; Peter A. Patriarca, MD)

Arizona State Immunization Information System (ASIIS)

Introduction: Personal telephone calls or postcard reminders have traditionally been used by childhood immunization programs to provide notices to parents that immunizations are due. The Pima County Health Department sought to explore other means to improve immunization rates. Preliminary research indicated that auto-dialers provided an effective and relatively inexpensive way to improve immunization rates. It is believed that auto-dialers can increase the patient "show rate" as well as reduce the cost of using other contact methods, such as appointment reminder letters or The $800 investment in an auto-dialer can be very cost-effective, especially for organizations that rely heavily upon staff time to conduct monthly reminder recall efforts. This is especially true in instances in which phone calls are being made individually by a staff person to remind parents of the need for upcoming immunizations. Using an autodialer instead, for this kind of an approach, is extremely cost effective and efficient. 

The autodialer provides a high level of customer service which can positively influence the recipients¹ perception of the professionalism and organization of the agency placing the call.
(From "Testing an Automated Reminder/Recall System to Improve Immunization Rates: Results of a Pilot Project" - ASIIS)

Lydia Robinson, City of Austin reported that "ReminderPro raised our immunization rate 37% and is helping us get ready to meet immunization goals for the year 2000. ReminderPro was a good tool to get our clerks ready for using computers because many didn't have computer skills. ReminderPro is an easy product to use and very effective."