Increasing pneumococcal vaccination in managed care through telephone outreach.

OBJECTIVES To determine the effectiveness of a telephone reminder to increase pneumococcal vaccination in a population that had received mailed reminders and to evaluate whether the intervention effect is similar for clinics serving primarily non-Hispanic black or non-Hispanic white patient populations. STUDY DESIGN Randomized trial within a managed care network. METHODS All unvaccinated patients 18 years and older with chronic medical conditions and 65 years and older without chronic medical conditions (N = 6106) were randomized to receive telephone intervention or standard care and followed up for 6-month vaccination status. The intervention was a telephone call initiated by a nurse to inform patients that pneumococcal vaccination was recommended and was a covered benefit of their insurance. RESULTS Intervention patients were 2.3 times as likely to be vaccinated during the study period than control patients (P < .001). The success of telephone intervention versus control was similar across clinics (P = .16) and across the chronic disease and elderly groups (P = .14). In subanalyses of individuals reached by telephone intervention, unvaccinated black subjects were less likely to be vaccinated during the study than unvaccinated white subjects (34% vs 25%, P = .03). Nurse staff time for telephone intervention cost $147.35 per additional patient vaccinated. CONCLUSIONS Telephone intervention was successful at increasing vaccination rates in a diverse managed care population that had already received mailed reminders. Tailored messaging for pneumococcal vaccination through telephone reminders increases patient demand for vaccination and should be implemented by managed care organizations seeking to increase their vaccination rates.