Initiation and completion of vaccination against human papilloma virus (HPV) is easier said than done based on vaccination rates across the country that would not make the vaccination rate honor roll. Since some offices may lack the bandwidth to make reminder calls, would a centralized call system at a statewide level be just what the doctor ordered to increase vaccination rates against HPV? Szilagyi et al. (10.1542/peds.2019-2689) evaluated this in a new study being early released this month. The authors performed a 4-arm pragmatic randomized controlled trial in New York and Colorado involving pediatric, family medicine, and health center practices. Teens were identified in randomly selected practices who had not completed their HPV series and these families then received anywhere from 0 to 3 autodialer reminder-recall phone calls from a state immunization information system for each vaccine dose needed with messages in English or Spanish, noting the name of the practice and number to call for an appointment. The outcome was whether vaccines were initiated, or the full series completed. Sadly in both states the results as reported are unimpressive—with no real differences noted in initiation or completion rates although there a is a barely statistically significant increase in vaccine initiation and completion rates in Colorado but this is probably not clinically significant.
So what happened? Why did auto-dialer reminder-recall telephone calls not work to get teens vaccinated against HPV? We invited Drs. Sarah Geoghegan and Kristen Feemster from Children’s Hospital of Philadelphia to provide us with a commentary (10.1542/peds.2019-3596). They suggest a number of reasons why auto-dialed calls may not popular, even if personalized to a practice. One key reason is our natural aversion to “robo-calls” –meaning we tend to ignore these by not paying attention to them or even answering them even when they might be of value as they were intended to be in this case. The authors raise the issue of trying texting messages rather than calling which was not tried in this study as well as other strategies that might include education in the provider’s office in combination with reminder calls and other more personalized approaches. Rather than hang up on what this study tried to do but failed, inject some time and effort into learning from it and the commentary so you can incorporate a phone reminder strategy along with other strategies suggested to improve the HPV rates in your own practice.
