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Meta-Analysis
. 2014 Jul 7;2014(7):CD005188.
doi: 10.1002/14651858.CD005188.pub3.

Interventions to increase influenza vaccination rates of those 60 years and older in the community

Roger E Thomas  1 , Diane L Lorenzetti
Affiliations
Meta-Analysis

Interventions to increase influenza vaccination rates of those 60 years and older in the community

Roger E Thomas et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: The effectiveness of interventions to increase the uptake of influenza vaccination in people aged 60 and older is uncertain.

Objectives: To assess access, provider, system and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.

Search methods: We searched CENTRAL (2014, Issue 5), MEDLINE (January 1950 to May week 3 2014), EMBASE (1980 to June 2014), AgeLine (1978 to 4 June 2014), ERIC (1965 to June 2014) and CINAHL (1982 to June 2014).

Selection criteria: Randomised controlled trials (RCTs) of interventions to increase influenza vaccination uptake in people aged 60 and older.

Data collection and analysis: Two review authors independently assessed study quality and extracted influenza vaccine uptake data.

Main results: This update identified 13 new RCTs; the review now includes a total of 57 RCTs with 896,531 participants. The trials included community-dwelling seniors in high-income countries. Heterogeneity limited meta-analysis. The percentage of trials with low risk of bias for each domain was as follows: randomisation (33%); allocation concealment (11%); blinding (44%); missing data (49%) and selective reporting (100%). Increasing community demand (32 trials, 10 strategies)The interventions with a statistically significant result were: three trials (n = 64,200) of letter plus leaflet/postcard compared to letter (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15); two trials (n = 614) of nurses/pharmacists educating plus vaccinating patients (OR 3.29, 95% CI 1.91 to 5.66); single trials of a phone call from a senior (n = 193) (OR 3.33, 95% CI 1.79 to 6.22), a telephone invitation versus clinic drop-in (n = 243) (OR 2.72, 95% CI 1.55 to 4.76), a free groceries lottery (n = 291) (OR 1.04, 95% CI 0.62 to 1.76) and nurses educating and vaccinating patients (n = 485) (OR 152.95, 95% CI 9.39 to 2490.67).We did not pool the following trials due to considerable heterogeneity: postcard/letter/pamphlets (16 trials, n = 592,165); tailored communications (16 trials, n = 388,164); customised letter/phone-call (four trials, n = 82,465) and client-based appraisals (three trials, n = 4016), although several trials showed the interventions were effective. Enhancing vaccination access (10 trials, six strategies)The interventions with a statistically significant result were: two trials (n = 2112) of home visits compared to clinic invitation (OR 1.30, 95% CI 1.05 to 1.61); two trials (n = 2251) of free vaccine (OR 2.36, 95% CI 1.98 to 2.82) and one trial (n = 321) of patient group visits (OR 24.85, 95% CI 1.45 to 425.32). One trial (n = 350) of a home visit plus vaccine encouragement compared to a home visit plus safety advice was non-significant.We did not pool the following trials due to considerable heterogeneity: nurse home visits (two trials, n = 2069) and free vaccine compared to no intervention (two trials, n = 2250). Provider- or system-based interventions (17 trials, 11 strategies)The interventions with a statistically significant result were: two trials (n = 2815) of paying physicians (OR 2.22, 95% CI 1.77 to 2.77); one trial (n = 316) of reminding physicians about all their patients (OR 2.47, 95% CI 1.53 to 3.99); one trial (n = 8376) of posters plus postcards (OR 2.03, 95% CI 1.86 to 2.22); one trial (n = 1360) of chart review/feedback (OR 3.43, 95% CI 2.37 to 4.97) and one trial (n = 27,580) of educational outreach/feedback (OR 0.77, 95% CI 0.72 to 0.81).Trials of posters plus postcards versus posters (n = 5753), academic detailing (n = 1400) and increasing staff vaccination rates (n = 26,432) were non-significant.We did not pool the following trials due to considerable heterogeneity: reminding physicians (four trials, n = 202,264) and practice facilitators (three trials, n = 2183), although several trials showed the interventions were effective. Interventions at the societal level We identified no RCTs of interventions at the societal level.

Authors' conclusions: There are interventions that are effective for increasing community demand for vaccination, enhancing access and improving provider/system response. Heterogeneity limited pooling of trials.

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Conflict of interest statement

Roger E Thomas: none known. Diane L Lorenzetti: none known.

Figures

Figure 1
Figure 1
'Risk of bias' summary: review authors' judgments about each risk of bias item for each included study.
Figure 2
Figure 2
'Risk of bias' graph: review authors' judgments about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
Funnel plot of comparison: 1 Increasing community demand, outcome: 1.1 Client reminder and recall (letter or postcard or pamphlet) compared to no intervention.
Figure 4
Figure 4
Funnel plot of comparison: 1 Increasing community demand, outcome: 1.2 Client reminder and recall (tailored letter or postcard or phone call) compared to no intervention.
Figure 5
Figure 5
Forest plot of comparison: 1 Increasing community demand, outcome: 1.1 Client reminder and recall (letter or postcard or pamphlet) compared to no intervention.
Figure 6
Figure 6
Forest plot of comparison: 1 Increasing community demand, outcome: 1.2 Client reminder and recall (tailored letter or postcard or phone call) compared to no intervention.
Analysis 1.1
Analysis 1.1
Comparison 1 Increasing community demand, Outcome 1 Client reminder and recall (letter or postcard or pamphlet) compared to no intervention.
Analysis 1.2
Analysis 1.2
Comparison 1 Increasing community demand, Outcome 2 Client reminder and recall (tailored letter or postcard or phone call) compared to no intervention.
Analysis 1.3
Analysis 1.3
Comparison 1 Increasing community demand, Outcome 3 Client reminder and recall (letter + leaflet or postcard) compared to letter.
Analysis 1.4
Analysis 1.4
Comparison 1 Increasing community demand, Outcome 4 Client reminder and recall (customised letter or phone call) compared to form letter.
Analysis 1.5
Analysis 1.5
Comparison 1 Increasing community demand, Outcome 5 Client reminder and recall (telephone call from senior plus educational brochure) compared to usual publicity.
Analysis 1.6
Analysis 1.6
Comparison 1 Increasing community demand, Outcome 6 Client reminder and recall (telephone invitation) compared to invitation to patient when "dropped in" to clinic.
Analysis 1.7
Analysis 1.7
Comparison 1 Increasing community demand, Outcome 7 Brochure + lottery for free groceries compared to no intervention.
Analysis 1.8
Analysis 1.8
Comparison 1 Increasing community demand, Outcome 8 Client‐based education (health risk appraisal) compared to no intervention.
Analysis 1.9
Analysis 1.9
Comparison 1 Increasing community demand, Outcome 9 Client‐based education (nurses or pharmacists educated and nurses vaccinated patients) compared to no intervention.
Analysis 1.10
Analysis 1.10
Comparison 1 Increasing community demand, Outcome 10 Client‐based education (nurses educated and vaccinated patients) compared to nurses educated patients.
Analysis 2.1
Analysis 2.1
Comparison 2 Enhancing access, Outcome 1 Group visits of patients to physician and nurse compared to usual care.
Analysis 2.2
Analysis 2.2
Comparison 2 Enhancing access, Outcome 2 Home visit compared to invitation to attend influenza vaccination clinic.
Analysis 2.3
Analysis 2.3
Comparison 2 Enhancing access, Outcome 3 Home visit with encouragement to receive influenza vaccination, compared to home visit with safety intervention.
Analysis 2.4
Analysis 2.4
Comparison 2 Enhancing access, Outcome 4 Home visit by nurse or group sessions with encouragement to receive influenza vaccination, plus care plan developed with physician, compared to no intervention.
Analysis 2.5
Analysis 2.5
Comparison 2 Enhancing access, Outcome 5 Free influenza vaccine compared to invitation to be vaccinated but patient pays.
Analysis 2.6
Analysis 2.6
Comparison 2 Enhancing access, Outcome 6 Free influenza vaccine compared to no intervention.
Analysis 3.1
Analysis 3.1
Comparison 3 Provider‐ or system‐based intervention, Outcome 1 Reminder (to physician) compared to no reminder.
Analysis 3.2
Analysis 3.2
Comparison 3 Provider‐ or system‐based intervention, Outcome 2 Reminder to physician about all patients compared to reminder about half patients.
Analysis 3.3
Analysis 3.3
Comparison 3 Provider‐ or system‐based intervention, Outcome 3 Reminder (to hospital staff to vaccinate patient) compared to letter to GP on day of discharge.
Analysis 3.4
Analysis 3.4
Comparison 3 Provider‐ or system‐based intervention, Outcome 4 Posters in clinic displaying influenza vaccination rates to encourage doctors to compete, plus postcards to patients, compared to no intervention.
Analysis 3.5
Analysis 3.5
Comparison 3 Provider‐ or system‐based intervention, Outcome 5 Posters in clinic displaying influenza vaccination rates to encourage doctors to compete, plus postcards to patients, compared to poster displaying vaccination rates.
Analysis 3.6
Analysis 3.6
Comparison 3 Provider‐ or system‐based intervention, Outcome 6 Facilitator encouragement of prevention manoeuvres including influenza vaccination compared to no intervention.
Analysis 3.7
Analysis 3.7
Comparison 3 Provider‐ or system‐based intervention, Outcome 7 Educational reminders, academic detailing and peer comparisons to physicians compared to mailed educational materials.
Analysis 3.8
Analysis 3.8
Comparison 3 Provider‐ or system‐based intervention, Outcome 8 Chart review and feedback to physician plus benchmarking to vaccination rates achieved by top 10% of physicians, compared to chart review and feedback.
Analysis 3.9
Analysis 3.9
Comparison 3 Provider‐ or system‐based intervention, Outcome 9 Educational outreach + feedback to practice teams versus written feedback to practice teams.
Analysis 3.10
Analysis 3.10
Comparison 3 Provider‐ or system‐based intervention, Outcome 10 Payment to physicians versus no payment.
Analysis 3.11
Analysis 3.11
Comparison 3 Provider‐ or system‐based intervention, Outcome 11 Intervention to increase staff influenza vaccination rate versus no intervention.
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Update of

Comment in

References

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References to other published versions of this review

    1. Thomas RE, Russell M, Lorenzetti D. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2010, Issue 9. [DOI: 10.1002/14651858.CD005188.pub2] - DOI - PubMed

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