Mailed reminders for area-wide influenza immunization: a randomized controlled trial

J Am Geriatr Soc. 1999 Jan;47(1):1-5. doi: 10.1111/j.1532-5415.1999.tb01893.x.


Objective: To determine if mailed reminders would increase area-wide influenza immunization for persons aged 65 and older.

Design: A randomized, controlled trial.

Setting: Ten counties in Indiana.

Participants: Using a Medicare database, 10,000 subjects were selected randomly from 10 counties in Indiana and randomized for the study. Using pre-established criteria, 4503 persons in the control group and 4508 in the intervention group were eligible for study.

Intervention: Intervention subjects received mailed reminders during the immunization season of 1995.

Measurements: Data from mailed surveys, Medicare claims, and phone calls were used to determine immunization rates.

Results: Of those surveyed who received immunization, only 63.4% filed a Medicare claim. Immunization rates were high in both groups but higher in the intervention group, 69.0% versus 64.2%. Age, presence of lung disease, assignment to the intervention group, presence of heart disease, and an age-sex interaction term were significantly and independently related to immunization.

Conclusions: The Healthy People Year 2000 goal (60% immunization for persons 65 and older) was exceeded in this population. Medicare claims data do not reflect immunization rates accurately. Mailed reminders, an inexpensive intervention, increased immunization rates area-wide and have potential for cost savings.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Age Factors
  • Aged
  • Correspondence as Topic*
  • Female
  • Heart Diseases / psychology
  • Humans
  • Indiana
  • Influenza Vaccines*
  • Logistic Models
  • Lung Diseases / psychology
  • Male
  • Medicare
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Population Density
  • Reminder Systems*
  • Sex Factors
  • United States
  • Vaccination / statistics & numerical data*


  • Influenza Vaccines