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Table 2 Summary of eligible articles

From: Barriers to the use of reminder/recall interventions for immunizations: a systematic review

Author, year Methods Participants; setting Intervention/System Barriers
Birmingham 2011[32] Focus group 21 pediatricians/nurse practitioners; New York, US Computerized clinical reminders (CCRs) for influenza/electronic health records (EHR) · Too much pop-up information makes it easy to ignore all alerts
· Mixed confidence in reliability and accuracy of EHR alerts
· Strongly opposed to alerts that interrupted workflow or forced an action before continuing documentation in a note
· Concern that alerts will strain nursing staff
Clark 2006[26] Mail survey 756/1235 family physicians; 15 states in the US Patient immunization history tracking for RR interventions/state immunization registry · Too much cost/staff time
· Insufficient technology assistance
Dombkowski 2007[28] Mail survey 389/600 pediatricians and family physicians; Michigan, US Patient immunization history tracking for RR interventions/state immunization registry · Accuracy of Medicaid data used to identify children with asthma and the potential restriction of the registry’s high-risk indicator to only Medicaid patients
· Consistent access to the registry
· Overall accuracy and completeness of registry data
· Staff not accustomed to using registry to check patients’ immunization status
Deutchman 2000[27] Mail survey 158/250 family physicians with pediatric patients; rural Colorado, US Patient immunization history tracking for RR interventions/no specific system · Integration of new system into current computerized functions
· Patient confidentiality
· Costs, staff time associated with using the system to track patients
Fung 2004[30] Survey 261/1304 clinical staff or informatics experts from 142 Veterans Health Administration (VHA) facilities; US CCRs including for immunizations/EHR · Perceived utility of CCRs, training and personnel support for computer use, EHR functionalities and performance data feedback to providers at each facility
Humiston 2009[33] Focus groups 24 family physicians and nurses; New York, US Patient immunization history tracking for RR interventions/no specific system · Difficulties in identifying which adolescents were vaccinated, especially due to frequent moves
· Neither EMR nor state registries are helpful given poor communication between school and primary care offices
Saville 2011[31] Semi-structured interviews 24 pediatricians, nurses and practice administrators from 11 practices; Colorado, US Patient immunization history tracking for RR interventions/state immunization information system · Difficulties overcoming the obstacle of inaccurate contact information
· Perceptions of low compliance with recall notices for certain risk groups
· Perceived conflicts in the immunization algorithms between registry and the practice.
· Lack of dedicated time and personnel for recall activities
· Inaccuracies both with patient contact information and immunization data in system;
patient contact information was not routinely updated in system, only in EHR
· Unmet expectations for responses to recall efforts can lead to method discontinuation
· Extra time required to crosscheck recall with appointment schedules to ensure under-immunized patients have not already planned physician visit
Tierney 2003[23] Semi-structured interviews and surveys 18 clinician-administrators representing adopters and non-adopters; 912 (76%) pediatricians and public health staff completed surveys; US Patient immunization history tracking for RR interventions/no specific system · Both adopters and non-adopters of reminder or recall messages identified time and money as the most important barriers to implementing these methods.
· Not having a simple way of identifying children at a specific age, review records or begin an initiative
· Lack of knowledge about how to get started and limited computer skills were named as barriers by only 10% to 18% of respondents in any subgroup
Wallace 2004[34] Semi-structured interviews, questionnaires, group discussions Clinicians at 23 Spinal Cord Injury (SCI) centers in the VHA; US CCRs for influenza/EHR · Lack of coordination between EHR and vaccination data so cannot be sure patient has not been vaccinated elsewhere unless extra work is done
· Different forms (and locations) for inpatients and outpatients is frustrating for clinicians
· Lack of training can result in inadequate information that is not useful
· Lack of access for all immunization staff
Yarnall 1998[29] Survey Physicians caring for a sample of 1314 study patients in a large community health centre*; North Carolina, US CCRs including those for immunizations/computerized health maintenance system · Lack of time
· Additional workload as staff still need to use and complete paper maintenance forms
  1. This table summarizes key details of the 10 articles included in the systematic review.
  2. *Number of physicians not reported.