Effect of outreach reminders on adolescent well child visits and COVID-19 vaccination rates: A randomized clinical trial

DENVER, April 22, 2022 – Researchers with Cincinnati Children's Hospital Medical Center conducted a randomized clinical trial to determine the effectiveness of outreach reminders on adolescent well child visits and COVID-19 vaccination rates. Findings from the trial will be presented during the Pediatric Academic Societies (PAS) 2022 Meeting, taking place April 21-25 in Denver.

 

Many adolescents delayed preventative services during the COVID-19 pandemic. Outreach is a proven strategy for increasing preventative services, but it was uncertain whether this would be effective amid the pandemic.

 

The trial determined that outreach messages were minimally effective at re-engaging adolescents in preventative services. Efforts are needed to address widening disparities.

 

"We provide a primary care medical home for a low income Black population that was profoundly impacted by the pandemic,” said Mary Burkhardt, MD, MHA, associate division director of primary care at Cincinnati Children's Hospital Medical Center. “We conducted this trial to better understand the impact of reminders to adolescents about care that was overdue and the opportunity to receive the COVID-19 vaccine. We found that our interventions did promote scheduling of adolescent well care visits, but were minimally effective at improving the completion of visits. Higher intensity interventions may be needed to re-engage patients and address widening disparities.”

 

The trial included text and telephone outreach messages, with and without information about COVID-19 vaccine availability, on the scheduling and completion of adolescent well-care visits among adolescents due for preventative services.

 

Dr. Burkhardt will present “Effect of Outreach Reminders on Adolescent Well Child Visits and COVID-19 Vaccination Rates: A Randomized Clinical Trial” on Sunday, April 24 at 8 a.m. MDT. Reporters interested in an interview with Dr. Burkhardt should contact PAS2022@piercom.com.

 

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

 

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About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting, Instagram PASMeeting and #PAS2022, and like us on Facebook PASMeeting. 

 

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Abstract: Effect of Outreach Reminders on Adolescent Well Child Visits and COVID-19 Vaccination Rates: A Randomized Clinical Trial

 

Topic

General Pediatrics: Primary Care/Prevention

 

Presenting Author

Mary Burkhardt, MD, MHA

 

Organization

Cincinnati Children's Hospital Medical Center

 

Background

Many adolescents delayed preventative services during the COVID-19 pandemic. Outreach is a proven strategy for increasing preventative services, but it was uncertain whether this would be effective amid the pandemic.

 

Objective

To determine the effectiveness of text and telephone outreach messages, with and without information about COVID-19 vaccine availability, on the scheduling and completion of adolescent well-care (AWC) visits among adolescents due for preventative services.

 

Design/Methods

We conducted an intent-to-treat, multi-arm, randomized clinical trial from May 28 to August 5, 2021 at three academic pediatric primary care practices serving 36,000 predominantly minority, low-income children. We randomized 1,235 adolescents 12-17 years old to a Standard Message group, a COVID-19 Vaccine Message group, or a No Message group (control group). We delivered two automated text reminders or phone calls (based on family preference) to the message groups using a HIPAA compliant platform (Figure 1). As some patients did not receive messages as intended, we also conducted a per-protocol analysis excluding these patients. We used logistic regression models to examine AWC visit scheduled within 2 weeks, AWC visit completed within 8 weeks (primary outcome), and receipt of vaccines (Tdap, HPV, MCV4, COVID-19) within 8 weeks.

 

Results

The groups were similar (mean [SD] age=14 [1.5] years, 52% male, 77% Black, 4.1% Hispanic, 88% publicly insured) (Table 1). AWC visit scheduling rates were 10.4%, 6.6%, and 5.3% in the Standard Message, COVID-19 Vaccine Message, and control group, respectively. The Standard Message group had higher odds of scheduling an AWC visit compared to the control and COVID-19 Vaccine Message groups (Table 2). Despite relative differences in the rate of completed AWC visits across the Standard Message (13.6%), COVID-19 Vaccine Message (13.4%), and control groups (10.4%), the odds did not differ significantly. Among those in the Standard Message, COVID-19 Vaccine Message, and control groups who received Tdap (13% vs. 17% vs. 2%), HPV (12% vs. 10% vs. 7%) and MCV4 (12% vs. 10% vs. 2%), the odds of receiving Tdap and MCV4 within 8 weeks differed significantly, with the message groups outperforming the control group. In per-protocol analyses, but not intent-to-treat analyses, adolescents in the Standard Message group (4.7%) were twice as likely as the control group (1.9%) to receive the COVID-19 vaccine (OR, 2.48 [95% CI: 1.05-5.86]).

 

Conclusion(s)

Outreach messages were minimally effective at re-engaging adolescents in preventative services. Efforts are needed to address widening disparities.

 

Tables and Images

Figure 1: Outreach Messages

Table 1: Baseline Characteristics

Table 2: Intention to Treat Analysis

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