private providers; introducing immunization services in nontraditional medical settings (e.g., emergency departments or acute care clinics); linking immunization assessment efforts with other services that involved high-risk families (e.g., Head Start, WIC clinics, and the welfare system); and encouraging health professionals to offer simultaneous immunizations during acute care appointments (Orenstein et al., 1999). Four such provider-based interventions have been evaluated in the research literature (Briss et al., 2000):

  • provider reminder-recall,

  • provider assessment and feedback,

  • standing orders, and

  • provider education.

Provider Reminder-Recall. This strategy involves alerting those who administer vaccinations that individual clients are due (reminder) or overdue (recall) for particular vaccinations. Issued before, during, or after a scheduled appointment, such notices can be provided through such means as client charts, computer records, or mail.

Provider reminder-recall has been shown to improve vaccination coverage for various age groups (adults, adolescents, and children) in a range of settings and populations (Briss et al., 2000). Positive impacts have been demonstrated whether the reminder notice was used alone or as part of a comprehensive intervention. Positive results were also associated with a range of methods (e.g., computerized or simple reminders, checklists, or flowcharts).

The TFCPS task force strongly recommends the use of reminder-recall interventions to improve vaccination coverage for all age groups. However, some studies have revealed that provider offices experience difficulty with placing reminders in charts, and some health care professionals do not use reminders when provided, suggesting that the administrative burden associated with this strategy may be a major barrier to its use (Briss et al., 2000). Lack of information about vaccination status may also inhibit use of this approach. A 1992 study indicated that fewer than 20 percent of providers operated any kind of credible reminder-recall system (Szilagyi et al., 1992). A 1999 study led to a similar finding (Darden et al., 1999).

Provider Assessment and Feedback. Many providers tend to overestimate the coverage rates of their clients. In a California study, for example, physicians estimated that about 90 percent of their patients were up to date, although record audits indicated that the actual rate was well below 70 percent (Watt et al., 1998). Assessment and feedback interventions (also

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